By ALEX COSTELLO
But now, other drug-resistant infections have started to become more predominant in hospitals and in the community as well.
“From the MRSA perspective, the best thing that happened was that it got public traction,” said Dr. Josh Kugler, senior vice president and chief medical officer at South Nassau Communities Hospital. “When the customer, or the consumer in this case, understands the disease, they actually query the physician.”
Kugler said that MRSA becoming well-known by the public was a key factor in getting the disease under control. If the public knows it exists, a person can ask their doctor to test for it - and potentially diagnose it early on while it is treatable.
The reason that MRSA even became a problem in the first place, according to Kugler, is that doctors just didn’t know to look for it.
“We typically were told [MRSA] is something that was relatively uncommon,” said Kugler. “So when someone gets an infection, particularly of the skin, we would treat it like it's a standard staph infection.”
Staph infections are bacterial infections of the skin. Most can be treated easily with antibiotics, methicillin being a common prescription. However, the problem that doctors are facing now with staph and other infections is that the diseases are starting to become resistant to the antibiotics that doctors use, hence their nickname, “superbugs.”
“It's that business of inappropriate use of antibiotics,” said Susan Weiser, a SNCH nurse and infectious disease specialist. “Outside practitioners, occasionally I'm sure, are prescribing antibiotics for illnesses that may not need them and may not be infections. And when you do that, in the outside, you can also have the ability to create this kind of shift and resistance in organisms as well.”
Overuse of antibiotics is a problem that healthcare officials said has caused many organisms to become drug-resistant. At any given time, a person carries around a multitude of bacteria that can be killed by taking a broad-spectrum antibiotic. So if the person is carrying X, Y and Z bacteria, even if those bacteria are not what is making the person sick, those harmless bugs are also killed off by the treatment. But whatever members of the X, Y, and Z bacteria the person has left in his or her system are now resistant to the antibiotic that was taken. If the person passes the bacteria to someone else, and the bacteria make the other person sick, the antibiotics won’t work.
“It's like giving Superman kryptonite, but teaching him how to become resistant to kryptonite,” Kugler said. “Giving him little doses where his body learns to change.
“The bugs that we normally are carrying with us...are now getting more resistant,” Kugler continued. “They're getting stronger.”
And the stronger bugs infect those with weakened immune systems. Doctors have learned that people in nursing homes, those in living in close quarters, and people with chronic diseases that weaken their immune system are more likely to become infected with MRSA and other resistant diseases.
According to the CDC Web site, the most common mode of MRSA transmission is through the hands, usually of healthcare workers. It used to be that if a worker in a hospital works with a patient that has MRSA or another resistant infection, they can then spread that infection to other patients in the hospital. But hospitals have learned about how these infections are spread and are doing their best to combat them.
“We're doing a really good job as far as controlling,” Weiser said. “The hospital has systems and programs in place so that we identify patients with resistant organisms from the time they come through the door. They're maintained in isolation.”
The problem for many doctors is not only diagnosing someone with antibiotic-resistant infections, but also treating them, especially if the infection has spread. An infection can spread from the area of the initial infection and start to affect a patient’s organs, which is called sepsis. When a patient becomes septic, it becomes much harder for doctors to treat them.
“It takes a multidisciplinary approach to treat people who come in with superbugs,” Kugler said. “You need the primary care physician to coordinate the care with multiple specialties, including infectious disease specialists and the clinical and laboratory because they need to do the culturing.” Treating a septic patient can also involve cardiologists if the infection has gone to the patient’s heart and other specialists if other organs are involved.
“So not only is the primary care involved, but you may have five or six doctors trying to coordinate care around identifying the proper bug, diagnosing it, and then treating it,” said Kugler. “And the right treatment may involve ten different medications now.”
The key to preventing resistant strains of bacteria from spreading, according to Kugler, is the judicial use of antibiotics. Doctors need to stop giving into patients’ demands for antibiotics, he said, and take the time to do cultures and properly diagnose a disease before treating it. In that way, with a more targeted approach to antibiotic use, the spreading of resistant strains can be curtailed.
And, according to Weiser, there is an easy way to prevent catching the bugs to begin with: hand washing. “In healthcare today, our focus is on maintaining adherence to meticulous hand washing,” said Weiser. “Forget superbugs, that's the No. 1 way to prevent transmission of infection.”
Comments about this story? ACostello@liherald.com or (516) 569-4000 ext. 207.
