running head: SUPERBUGS Humphreys 1

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1 running head: SUPERBUGS Humphreys 1 Superbugs GCH 360 Term Paper Assignment Kelly Humphreys April 30, 2014

2 SUPERBUGS Humphreys 2 Introduction The World Health Organization (WHO) recognizes antibiotic resistance as the resistance of common bacterial strains to antibiotic treatment. The WHO brings into consideration the concept of antimicrobial resistance (AMR). AMR encompasses bacteria, but viruses, fungi, parasites, and so on. Both antibiotic resistant bacteria and antimicrobial resistant microorganisms are problems on a global level. Microorganisms are also referred to as pathogens, also interchangeable with the term microbes all of which can be superbugs. The most critical concern is superbugs have evolved and mutated to decrease or obliterate projected outcomes of standard treatment. Many illnesses that were formally treatable have become untreatable as a result of this treatment resistance. (World Health Organization, 2014). Antibiotic drugs are a form of antimicrobial drug targeted to specifically kill bacteria. Examples of common antibiotics are tetracycline, amoxicillin, penicillin, etc. Antimicrobial drugs treat a much broader array of infections. Antimicrobial drugs include antifungals, antivirals, antibacterial, and ant parasitic medications. Resistance in response to these forms of medication is how the term superbugs came into being. Background The drastic rise in the number of antibiotic resistant bacteria is primarily due to human error. Human errors are individual, physician, and patient fault. These errors include anything from antibiotic misuse to over prescription (APUA, 2013).

3 SUPERBUGS Humphreys 3 An example of antibiotic misuse is when someone does not finish their antibiotic regimen because symptoms of their bacterial infection have gone away, and the patient no longer sees the need to continue the medication. This causes the bacteria to potentially live without being completely killed off, enabling mutation against the antibiotic exposure for future survival. An example of over prescription is when doctors prescribe antibiotics to patients for viral infections, such as the common cold (Alliance For The Prudent Use of Antibiotics, 2013). Historically, treatment that was once effective in treating infections from microorganisms. Superbugs are a major threat to human health and pose problems for disease management due to a rising number of antibiotic failure treatment outcomes (CDC Antibiotic/Antimicrobial Resistance, 2010). Due to evolution of these microorganisms, past treatment no longer have the same results. Complications that arise from antimicrobial and antibiotic resistant strains of microorganisms include increased incidence of death rates, loss of public health control over illnesses (reduced containment), increased healthcare costs, poor health security in communities, reduced international trade, and a negative impact for the economies for numerous countries (WHO, Antimicrobial Resistance, 2014). Some examples of antimicrobial and antibacterial resistant microorganisms provided from the World Health Organization are everyday bacteria responsible for conditions such as urinary tract infections. Other rare microorganisms responsible for critical diseases include those of tuberculosis, MRSA, staphylococcus, E. coli,

4 SUPERBUGS Humphreys 4 influenza, malaria, other hospital-acquired infections, etc. These various pathogens demonstrate the range of resistance from the common infection to severe fatal illnesses. What all these AMR s have in common is what public health fears most evolving endurance while having no treatment alternatives. Methicillin-Resistant Staphylococcus Aureus - MRSA Methicillin-resistant staphylococcus aureus is a staph bacterium better known as MRSA. MRSA is predominantly a hospital-acquired infection that is resistant to most forms of antibiotics. People in close contact with other people can also spread MRSA in the community. This is commonly seen in high school sports teams, especially wrestling and football (U.S. National Library of Medicine, 2014). MRSA is spread through direct contact with infections of the skin or wounds. MRSA can also be spread from healthcare staff to others failing to sanitize hands after coming into contact with MRSA. It is possible to infect a person from contact with another exhibiting no symptoms. The symptoms associated with MRSA vary from one individual to the next. Common symptoms of this staph bacterial infection include blood infection aka sepsis, wound infection, skin infection, and infection of the lower respiratory tract, sometimes causing pneumonia (Vilasak and Thammavongsa, 2009). The only way to confirm a MRSA infection is to culture the bacteria (CDC MRSA, 2013). Since treating MRSA is difficult with the barrier of antibiotic resistance, the best thing to do is focus on prevention to acquiring the infection. Prevention of MRSA comes down to the simple habit of hygiene. Preventative measures include

5 SUPERBUGS Humphreys 5 washing hands, covering open wounds with bandages, not sharing toiletries or personal hygiene items (like razors or towels), and avoiding contact with other people s wounds and soiled bandages. Multi-Drug Resistant Neisseria Gonorrhea Neisseria gonorrhea is the scientific name for the bacterial infection commonly referred to as gonorrhea. Gonorrhea is a sexually transmitted disease that has been treatable by means of antibiotics in the past. Gonorrhea infects the reproductive system. It infects the cervix, uterus, and fallopian tubes in women. It also increases the risks of pelvic inflammatory disease and infertility in women. In both sexes, gonorrhea can infect the mouth, urethra, throat, eyes, and anus (NIAID, 2012). The infection can be passed on from mother to a newborn child, sometimes resulting in blindness. If the STD infection goes untreated, the risk of catching HIV is increased and many health complications arise. Currently, antibiotic resistant gonorrhea can only be treated effectively with one class of antibiotics - cephalosporin. All other antibiotic classes are ineffective at treating resistant gonorrhea. The bacteria responsible for the gonorrhea infection are quick to adapt and hide. It is known to bypass antibiotics by mutating its genetic makeup by picking the DNA pieces off of other bacteria. There is much concern about Neisseria gonorrhea becoming resistant to cephalosporin, leaving gonorrhea as an untreatable STD. In the United States, antibiotic resistant gonorrhea has become the second most reported infectious disease to date (NIAID, 2012). Due to the high incidence volumes, there is a major dependency upon cephalosporin to

6 SUPERBUGS Humphreys 6 treat this ever-mutating STD; lurking concern over how long until it becomes untreatable is unknown. Analysis of Superbugs The CDC published a threat report about antimicrobial resistant pathogens for the year The report statistically documented that two million people catch an antimicrobial resistant infection annually in the United States alone. Of these two million people, it is estimated twenty three thousand of them die from resistant infections. In the threat report of 2013, the CDC outlines an action plan to combat the growing incidence of antimicrobial resistant microbes. The strategic plan consists of four main areas. First, prevention followed by tracking/monitoring, improving antibiotic use, and lastly developing new pharmaceutical medications to treat resistant conditions. The CDC provides a list of resistant microbes in order from most urgent to least serious. In the list, resistant gonorrhea made number three within the category entitled urgent threat. MRSA was also ranked high, falling in the serious classification of AMR s being monitored (CDC, Threat Report, 2013). Conclusion From the most benign, common infections ranging to the most rare fatal infections, antibiotic and antimicrobial resistant superbugs are becoming an emerging concern. Many infections that were once treatable are now left with no

7 SUPERBUGS Humphreys 7 cure. The misuse and over prescription of antibiotics is a large factor leading to this epidemic. The potential for resistant pathogens to damage countries in terms of health security, economic standing, and healthcare spending is very probable. Additionally, on a global level, those in charge of international health are losing control and containment of diseases due to the growing lack of treatment options. The fact that community population s risks catching a resistant infection brings home the realities of the strength microorganisms have. These common infections could grow resistance and become deadly for some. Maintaining good hygiene and preventative measures is key to avoid suffering from any superbug, no matter how big or how small it is perceived to be.

8 SUPERBUGS Humphreys 8 References Vilasack, O. and Thammavongsa, S. (2009). Staphylococcus aureus synthesizes adenosine to escape host immune responses. The Journal of Experimental Medicine, [online] 206(11), p Available at: HYPERLINK " [Accessed 30 Apr. 2014]. APUA. (2013). General Background: What is Antibiotic Resistance? Retrieved from Alliance for the Prudent Use of Antibiotics: HYPERLINK " \l "1" Center for Disease Control and Prevention, (2014). General Information Healthcare Settings MRSA CDC. [online] Available at: HYPERLINK " - q4 [Accessed 18 Apr. 2014]. CDC. (2010, July 22). Antibiotic / Antimicrobial Resistance. Retrieved from Center for Disease Control and Prevention: HYPERLINK " CDC. (2013, April 3). Methicillin-resistant Staphylococcus aureus (MRSA) Infections. Retrieved from Center for Disease Control and Prevention: HYPERLINK

9 SUPERBUGS Humphreys 9 " - q4 CDC, (2014). Threat Report 2013 Antimicrobial Resistance CDC. [online] Available at: HYPERLINK " [Accessed 1 Apr. 2014]. References US Department of Health and Human Services. National Institutes of Health., (2014). Antimicrobial (Drug) Resistance in Gonorrhea. [online] Available at: HYPERLINK " /Pages/default.aspx" ia/pages/default.aspx [Accessed 30 Apr. 2014]. U.S. National Library of Medicine. (2014, April 23). MRSA. Retrieved from MedlinePlus: HYPERLINK " World Health Organization. (2014, April). Antimicrobial resistance: Fact Sheet. Retrieved from World Health Organization:

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