I see once again the “superbug” is in the news, with poor old North Shore Hospital attempting to control an outbreak by splitting up their wards. Having worked in such an environment, I know exactly how frustrating that can be for nursing staff. Reverse barrier nursing (gloves, gowns, caps and overshoes to protect the nurse rather than the patient) makes everything take twice as long. Doctors and hospital administrators also become frustrated because they often can’t admit patients to empty beds because the patient is “clean” and the room is “contaminated”. Or vice versa.
Extended Spectrum Beta Lactamase (ESBL) resistant bugs (superbugs) have really only been in the country for less than a decade but are already a real nuisance in hospitals. A contaminated patient is not normally at risk unless they are very sick or to be operated on. The ESBL bug is only a problem if it enters your bloodstream. Septicaemia (blood-borne infection) is fatal unless treated with an antibiotic, but ESBL is resistant to most, making it very hard to treat. Most people with ESBL, however, are merely carriers and are in no danger.
Microbiologists tend to blame the development of superbugs on the over-use of antibiotics. While this is true, I am not convinced that it is the overuse of antibiotics by GPs in the community that produces this sort of resistance, but rather the blind use of very broad spectrum antibiotics in hospital situations. Community organisms seem to maintain a certain level of resistance to an antibiotic and that level does not seem to rise or fall much. Despite the increase in MRSA and ESBL superbugs, most Staphylococcal infections of the skin seem to clear up with Augmentin, despite it’s being in use for 40 years, to use but one example. The levels of resistance and antibiotic recommendations for community diseases have barely changed over the last 20 years. In addition, people rarely seem to become ESBL positive in the community, even when they live with an ESBL family member. It seems to be a bug you almost entirely acquire in hospital
These two things suggest to me that it is not GPs handing out antibiotics for viral infections that causes the development of these resistant bacteria. Use of very-broad-spectum antibiotics in hospital increases every year. This is because one cannot wait for a microbiologist to tell you which type of bug and which type of antibiotic to use, if the patient is seriously ill. Bacterial cultures take days to get a result. Therefore one tends to simply hit the infection with everything you’ve got. The common practice is then to switch to the more specific antibiotic when the culture results return. I suspect that some bacteria manage to survive this massive onslaught for a couple of days and go on to be the ESBL of the future when the powerful antibiotics are stopped. I suspect that, if one carried the very-broad-spectrum regime on for a week to 10 days, this kind of resistance bug would not survive to form resistant colonies.
I firmly expect stroppy comments from microbiologists and pharmacists. Don’t disappoint me.