Nursing Safety: Antibiotic Reistance to Bacteria

25 November 2008

The Centers for Disease Control and Prevention recently released a study noting that more American deaths occur each year due to MRSA, an antibiotic-resistant bacterium, than due to the AIDS virus.  The Committee to Reduce Infection Deaths calculates that more than 100,000 Americans die annually due to hospital acquired infections.  Statistical reporting does vary.  The National Institutes of Health (NIH) estimates that 90,000 people in the US die annually due to hospital acquired infections.  This statistic was noted in an an April 2006 report from the NIH division, The National Institute of Allergy and Infectious Diseases. The NIH also notes in this report that this number rose from 13,300 deaths annually in 1992 to 90,000 in 2006.  The NIH also notes that approximately 2,000,000 patients in the US get an infection in hospitals annually.  Tracking suggests that this number is rising.  Experts note that hospitals provide more procedures such as joint replacements and transplants which increase the risk of infections and push the trend upward.  Also, an increasing amount of hospital patients suffer from immunosuppression due to cancer and AIDS which also contribute to the increased risk of cross infection.  For 2008, the Centers for Medicare and Medicaid Service  has stated that Medicare will no longer reimburse hospital bills for care relating to hospital acquired infections.  It is expected that this will cause hospitals to fund greater resources towards improved staffing and equipment for disinfection, MSRA screening, and isolation rooms.

Another challenge is the natural process of bacterial antibiotic resistance.  Bacteria acquire genes conferring antibiotic resistance by spontaneous DNA mutation, transformation, and a DNA transfer process carried by a plasmid (a small circle of DNA that can jump from one bacteria to another).  The FDA notes that there are many factors involved in the increasing use of antibiotics which, in turn, promote the natural process of bacterial resistance to antibiotics.  For example, the FDA cites that an increased use of day-care facilities for children corresponds to a doubling of the amount of doctor visits for ear infections (and antibiotic use) between 1975 and 1990.  The FDA notes that the antibiotic resistance trend is also partially due to immunocompromised patients living longer, increased chemotherapy and transplant recipients, routine antibiotic prescriptions, and homelessness.  Interestingly, the FDA notes that doctors are pressured by patients to prescribe antibiotics in cases where they may not be necessary.  The FDA is also investigating whether or not the use of antibiotics in food animals can lead to human diseases.
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