Your medical procedure and superbugs

Thud,
Thank you for the information on your Amikacin!

TimG,
Yes, it appears to me that many of our antibiotics are old. The Amikacin injected into Thud was developed in the same time period (1973- 1976). It does not pay to develop new antibioticx.

I was told that the cost to bring a new drug to the US market is about $1B. From an investment standpoint, it is far better to develop a drug for high cholesterol or high blood pressure that will be taken for the life of a patient versus an antibiotic that is only taken for a short period of time. (And is quickly duplicated by foreign drug manufacturers).

It is my understanding that only two US pharma companies are trying to develop new antibiotics (none by India pharma) and the research is now going to the Feds. Further only two new antibiotics were developed last year. The bacteria are evolving resistance at a faster rate.

Thanks for the lead on McKenna's book. Did you realize she was the speaker in the TED presentation I posted a link to?

Chask,

Very sorry to hear about the C diff. I understand that it is one of the three leading superbugs.

I have heard of others who have had a bout with a superbug after taking an antibiotic. Seems the initial antibiotic kills the good bacteria and that allows the superbug to flourish. It is my understanding that after testing they are then treated with a targeted antibiotic.

As I understand it, the probiotics are important in treating C diff in that you need to recolonize the good bugs in your system .... like they compete with the bad bugs? I have heard that some people need to do fecal transplants to recolonize their systems after a bout with C diff and that the procedure works well.

All the best and thanks for sharing your information.

I had never heard of C diff until dear Barbara wrote about it. Did not go back & look at her posts but believe she had fecal transplant.

After she wrote about it I researched online:
did the same when a fellow patient at physical therapy had to have knee replacement redone due to MRSA which I had heard of but had no real knowledge about

Those of us who have invasive procedures (& apparently even just breathe the air!) should have some awareness of these ' possibilities ' ..

Thank you'll for sharing !

Cool thread… it screams…Alchemy and Art and wonderful personal thought experiments.
I came up with my definition of Art if it is not too far afield of thread.. Art is a dimension that strips pretense… driven by our need to understand that which we don't'… from the staid to the sublime..
I haven't even had my brew ski's…I napped.. ER most of the nite.. Ok I have surely be come too clever by half and will retreat into a bit of quantum data that is looking for itself. Words are so much fricken fun.. I notice little things…y'all getting pretty,pretty good at it..fo real...

..

Purgatory,
Yes I had the same concern when my wife, a nurse practioners, was working. For patients who had obvious symptoms she could take precautions. But ther are superbug carriers, who carry the bacteria, but who for whatever reason show no symptoms and do not know they are spreading the bacteria. Of course this effects not just medical facilities but also gyms (as one poster indicated), airplanes, movie houses, restaurants, churches, etc. etc. .... anyplace people get together. It's just that medical facilities seem to be where sick folks congregate therefore your risk of exposure increases.

Right or wrong, my personal concern with hospitals (and walk-in clinics for that matter) is that more sick people walk out, than walk in. It's a great place to go to catch something...Super or otherwise...
Not like we have a choice, but medical care facilities are great places to avoid....JMHO

Purgatory said...
C-Diff is bad news. They have had several out breaks at the long care and PT center my wife works at. I am terrified of her bring this home with her, after her contact with infected patients. MYRSA is very common too there.

Another thing I am often perplexed that doctor's don't routinely warn about: the increased risk of C-diff (plus other SEs) for anyone taking various stomach acid reducing drugs, particularly proton pump inhibitors.

www.ncbi.nlm.nih.gov/pubmed/27021503

Somebody said...
Abstract
Background/Aims:

Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) are commonly prescribed for stress ulcer prophylaxis (SUP) in critically ill patients. Several studies have suggested that the use of PPIs is a potential risk factor for Clostridium difficile infection (CDI). We compared the incidences of CDI in the PPI group and H2RA group for SUP in critically ill patients.
Methods:

From August 2005 to July 2012, the incidences of CDI were retrospectively analyzed in patients who were admitted directly to intensive care units and stayed for more than 3 days. SUP-related CDI was defined as a CDI diagnosed during the SUP period. Patient clinical data were analyzed to identify potential risk factors for SUP-related CDI.
Results:

Of the 1,005 patients enrolled (444 patients received PPI and 561 received H2RA), 38 (3.8%) were diagnosed with SUP-related CDI.

The incidence of SUP-related CDI was considerably higher in patients who received PPI than in those who received H2RA (6.7% vs 1.8%). PPI use for SUP (odds ratio [OR], 3.3; confidence interval [CI], 1.5 to 7.1; p=0.003) and diabetes mellitus (OR, 2.3; CI, 1.2 to 4.7; p=0.019) were independent risk factors for SUP-related CDI.
Conclusions:

PPI therapy is associated with a higher risk of SUP-related CDI than H2RA therapy in critically ill patients.

www.ncbi.nlm.nih.gov/pubmed/25540023

Somebody said...
long PPI exposure (odds ratio (OR) (95% confidence interval (CI) = 2.03 (1.23 to 3.36), P = 0.006) and antibiotic use (OR (95% CI) = 2.52 (1.23 to 5.18), P = 0.012) were identified as independent predictors of CDI.
CONCLUSIONS:

Proton pump inhibitors are independent risk factors for the development of CDI in ICU patients. This risk is particularly exposed after two or more days of therapy.

After 2 days! How many are on permanent Tagamet or Prilosec?

Keep in mind that in the above studies indicating the proton pump inhibitors(such as Prilosec) are worse than the the histamine-2 receptor antagonists such as Tagamet, still even the less potent drugs can put you at risk for C-Diff and other SEs:


www.ncbi.nlm.nih.gov/pubmed/20458086

Somebody said...
METHODS:

We conducted a pharmacoepidemiologic cohort study, performing a secondary analysis of data collected prospectively on 101 796 discharges from a tertiary care medical center during a 5-year period. The primary exposure of interest was acid suppression therapy, classified by the most intense acid suppression therapy received (no acid suppression, histamine(2)-receptor antagonist [H(2)RA] therapy, daily proton pump inhibitor [PPI], and PPI more frequently than daily).
RESULTS:As the level of acid suppression increased, the risk of nosocomial C difficile infection increased..........................After adjustment for comorbid conditions, age, antibiotics, and propensity score-based likelihood of receipt of acid-suppression therapy, the association persisted, increasing from an odds ratio of 1 (no acid suppression [reference]) to 1.53 (95% CI, 1.12-2.10) (H(2)RA), to 1.74 (95% CI, 1.39-2.18) (daily PPI), and to 2.36 (95% CI, 1.79-3.11) (more frequent PPI). Similar estimates were found with a matched cohort analysis and with nested case-control techniques.
CONCLUSIONS:

Increasing levels of pharmacologic acid suppression are associated with increased risks of nosocomial C difficile infection. This evidence of a dose-response effect provides further support for the potentially causal nature of iatrogenic acid suppression in the development of nosocomial C difficile infection.

Post Edited (BillyBob@388) : 4/23/2016 10:32:40 AM (GMT-6)

Resistant organisms including MRSA (a gram-positive bug), and more recent, gram-negative organisms have developed resistance to most main stream antimicrobials and sometimes to all antibiotics. We are indeed losing the war to bacteria because of poor medical treatment.
The primary problems are an overutilization of antibiotics when not indicated...often we want antibiotics for sinus infections and other upper respiratory infections when the vast majority of these infections are caused by viruses. Infection control in hospitals is still poor. Watch if your physician and nurse wash their hands before they touch you. It is certainly better than 5 years ago....but not good. In my experience, physicians are our worst offenders of poor hand hygiene.
The use of antibiotics in animal feed have resulted in selecting out resistant strains as well.
In hospitals, we use too many antibiotics, for too long and produce resistant strains and c. difficile overgrowth infections. There is a national effort to decrease the use of antibiotics used indiscriminately. In fact, the Joint Commission is now "grading" hospitals on what they are doing to reduce these infections (ex. minimizing the use of urinary catheters, de-escalating antibiotics when cultures are received, decreasing hospital-acquired pneumonia, etc).

Probiotics in theory should decrease c. diff infections but the literature is "fuzzy"on whether they do anything.
My advice....always question why an antibiotic is prescribed. If needed, they can save lives. If not, we end up shooting ourselves in the foot by taking something that does more harm than good.

Paul