Antibiotic Resistance: ACrisis in HealthcareRachel L.
SchulzUniversity of Missouri – Kansas City AbstractThediscovery of antibiotics in the twentieth century revolutionized our healthcaresystem. As antibiotics were brought tocommercial use they made previously incurable illnesses and life-threateninginfections treatable (Sugerman, 2013). However, as with many innovations, complications can arise. The misuseand overuse of antibiotics have led to drug resistant bacteria. These bacteria, even when exposed to anantibiotic, can survive and continue to multiply (Nathan & Cars, 2014).
Drug resistance has been identified as one ofthe leading problems in the future of healthcare in both patient complicationsand healthcare costs (Wright, 2012). Antibiotic stewardship and the correct usage of antibiotics areessential in combating the crisis of antibiotic resistant bacteria. Kewords: antibiotic resistance, antibiotics,bacteria, antibiotic stewardship Antibiotic Resistance: A Crisis in HealthcareIn the last 75 years advances inantimicrobial technology have helped control infections and diseases that oncewere difficult to treat or even deadly (Sugerman, 2013). The most commonly known antimicrobials are antibiotics which targetbacteria. After the discovery of penicillin in 1928 a projection of aninfection free future had many people optimistic (Clardy, Fischbach, & Currie, 2009). In the ensuing years the easy access toantibiotics led to their overuse. Thisoveruse has clouded the bright future with super bugs resistant to many formsof antibiotics. These super bugs, alsoknown as antibiotic resistant bacteria, are one of the top concerns in thefuture of healthcare (Sugerman, 2013).
Penicillin was the firstcommercialized antibiotic discovered by Alexander Fleming in 1928 (Clardy, Fischbach, & Currie, 2009). In subsequent years more than twentydifferent antibiotics have been developed. Antibiotics work in a number of ways. They can interfere with the bacteria’s ability to repair its damagedDNA, they can stop the bacteria’s ability to make what it needs to grow newcells, or they can weaken the bacteria’s cell wall until it bursts (Clardy, Fischbach, & Currie, 2009).
Antibiotics are prescribed for a wide varietyof conditions from cellulitis to pneumonia and even sepsis. Antibiotics have revolutionized modernmedicine by making previously incurable illnesses and life-threateninginfections treatable (Nathan & Cars, 2014).Antibiotic resistance is theability of bacteria to resist the effects of an antibiotic that once would havekilled it (Wright, 2012). Resistant bacteria survive exposure to the antibiotic and are notkilled.
Instead, they continue tomultiply in the body and thrive potentially causing more harm and spreading toother people. Antibioticresistant bacteria can be traced to the overuse of antibiotics and inappropriateantibiotic treatment (Sugerman, 2013). Many antibiotics are frequently prescribed to treat symptoms or diseasesthat do not respond to antibiotics such as the common cold or other viruses (Sugerman, 2013). The overuse of antibiotics is not a newphenomenon. Instead, it has beenassociated with antibiotic resistance since 1945 when Alexander Fleming grewconcerned when he observed the emergence of antibiotic resistant bacteria.(Spellberg, 2016). In one study of the primary care system inseveral rural communities more than 60% of antibiotic prescriptions were foundto be inappropriate, with 78% of respiratory viruses being treated withantibiotics.
(Bell, 2014)Inappropriate antibiotictreatment or antibiotic misuse includes the failure of medical professionals toprescribe the correct dosage of antibiotics on the basis of the patient’s weightand history of prior use. Other forms ofmisuse include failure to take the entire prescribed course of the antibioticor the prescribing of an incorrect antibiotic for the bacterial sensitivity (Bell, 2014). Antibiotic resistant infectionsare a substantial health and economic burden to patients and their families aswell as to the broader healthcare system. These infections are common in hospitals, dueto the vulnerable patient population, the risk of invasive procedures, and highrates of antibiotic use (Bell, 2014). Nearly two million Americans per year develophospital acquired conditions resulting in 23,000 deaths, most due toantibacterial resistant pathogens (Sugerman, 2013). Even when effective treatments exist for the antibiotic resistantbacteria patients with resistant infections require significantly longerhospital stays, more doctor visits, and lengthier recuperations (Bell, 2014). Antibiotic resistant infections addconsiderable cost to the nation’s health care system.
The total economic burdenplaced on the U.S. economy by antibiotic resistant infections has beenestimated to be as high as $20 billion a year in health care costs and $35 billiona year in lost productivity (Sugerman, 2013). Improving the use of antibioticsis an important patient safety and public health issue as well as anational priority (Spellberg, 2016). In 2009 the CDC launched its firsteducational effort to promote improved use of antibiotics in acute caresettings (Wright, 2012).
In 2013 the CDC emphasized the need to improveantibiotic use as one of the key strategies needed to address the problem of antibioticresistance (Spellberg, 2016). In response to the increased education manyhospitals have created Antibiotic Stewardship programs. These programs emphasize the need toprescribe antibiotics based on the correct patient weight, the correct mode ofadministration, the correct duration of antibiotic treatment, and the narrowestband of antibiotics that will effectively treat the infection (Spellberg, 2016).
To be successful in these strategies thereneeds to be a combined effort of practitioners, pharmacists, and patients tomake sure that the antibiotic treatment falls in line with the CDCrecommendations. Additionally,stewardship programs should expand outside the acute care setting and into theprimary care setting. In conclusion, asmore facilities engage in efforts to optimize antibiotic usage, there is hopethat the crisis of widespread antibiotic resistance will be slowed andhopefully reversed. ReferencesBell, M. (2014, December). AntibioticMisuse: A Global Crisis. JAMA InternalMedicine, 174(12), 1920-1921.
Clardy, J., Fischbach, M., Currie, C.(2009). The natural history of antibiotics.
Current Biology(11), 437-441.Nathan, C. & Cars, O. (2014,November). Antibiotic Resistance- Problems, Progress, and Prospects.The New England Journal of Medicine, 1761-1763.Spellberg, B. (2016, March).
New SocietalApproaches to Empowering Antibiotic Stewardship JAMA, 1229-1230.Sugerman, D. (2013, November 27).Antibiotic Resistance. JAMA, 2212.
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