UK team promotes proper use of antibiotics to help thwart development of bacteria that are resistant to antibiotics

Graphic from The Conversation

By the Antimicrobial Stewardship Team
UK HealthCare Pharmacy Services

In the U.S., more than 2.8 million antimicrobial-resistant infections occur each year. Antimicrobials — a group of essential medications including antibiotics, antivirals, antifungals and antiparasitics — are used to prevent and treat infections in humans, animals and plants.

Antimicrobial resistance happens when germs like bacteria evolve to defeat the drugs that have been designed to kill them. Resistance has the potential to affect people at any stage of life, as well as health care, veterinary and agriculture industries. This makes antimicrobial resistance one of the world’s most urgent public health problems. Antibiotics can save lives when used appropriately to fight off bacterial infections, but they are not always the answer.

Here is some important information about responsible antibiotic use:

• Antibiotics do NOT treat viruses, like those that cause colds, flu, respiratory syncytial virus (RSV) or Covid-19. Other medications, like antivirals, can treat viruses.
• Antibiotics are only needed for treating certain infections caused by bacteria, but even some bacterial infections get better without antibiotics.
• When antibiotics aren’t needed they won’t help you and the side effects could still cause harm.
• If you need antibiotics, take them exactly as prescribed. Talk with your health care providers if you develop side effects or have questions about your antibiotics.
• Do your best to stay healthy and keep others healthy. This helps reduce antibiotic use and fights antimicrobial resistance.

What should you do when you feel sick?

• Contact your primary care provider.
• If you have been prescribed an antibiotic, take it the way it has been prescribed to you.
• Keep yourself and others around you healthy by washing your hands with soap and water for at least 20 seconds or using hand sanitizer containing at least 60% alcohol, covering your mouth and nose with a tissue when you cough or sneeze, staying home when you are feeling under the weather, and getting all recommended vaccines like the yearly flu vaccination.

For more information, follow the Centers for Disease Control and Prevention’s initiative, Be Antibiotics Aware: Smart Use, Best Care at www.cdc.gov/antibiotic-use/index.html.

About UK HealthCare's antimicrobial stewardship

At UK HealthCare, a dedicated team of pharmacists and physicians are fighting the battle against drug-resistant infections every day. The antimicrobial stewardship team is committed to overseeing the type, dose and duration of antimicrobials our patients receive to ensure the best possible clinical outcomes.

The mission of UK HealthCare’s antimicrobial stewardship program is to optimize antimicrobial use to improve clinical outcomes and decrease the spread of resistance.

“The antimicrobial stewardship team is on clinical services, so we evaluate patients and provide guidance on the right dose and duration of antibiotics through the ID-consult service,” said Donna Burgess, pharmacy coordinator of the antimicrobial stewardship program. “If antibiotics are not needed, we are able to discontinue use in order to decrease antibiotic resistance and protect patients from potential side effects.”

More action needed to protect patients from antibiotic-resistant infections, which kill an American every 15 minutes, CDC says

Cover of CDC report; to download it, click here.

More action is needed to protect Americans from antibiotic-resistant infections, 2.8 million of which occur in the U.S. each year, killing more than 35,000 people, one about every 15 minutes, says the federal Centers for Disease Control and Prevention.

On top of that, 12,800 people died from an infection that is not drug-resistant but is "caused by the same factors that drive antibiotic resistance—antibiotic use and the spread of germs," the CDC said in its report, Antibiotic Resistance Threats in the United States, 2019. "The number of people facing antibiotic resistance is still too high. More action is needed to fully protect people."

Hospitals are a main battleground in the fight. The word "hospital" appears 188 times in the 148-page report, which was issued days after the Leapfrog Group's latest rankings of patient safety at hospitals nationwide, including 50 in Kentucky. The most common grade, on an A-to-F scale, was a C, and the report showed that many hospitals had difficulty dealing with resistant infections.

The University of Louisville Hospital got a D overall in the Leapfrog Group's patient-safety ratings and was rated poorly in dealing with one of the major antibiotic-resistant infections, Methicillin-resistant staphlycoccus areus (MRSA), and C. diff, an infection related to the use of antibiotics. Click to enlarge.

The report's foreword, by CDC Director Robert Redfield, sums up the history of antibiotics in personal terms: "In March 1942, Mrs. Anne Miller of New Haven, Connecticut, was near death. Infectious germs had made their way into her bloodstream. Desperate to save her, doctors administered an experimental drug: penicillin, which Alexander Fleming discovered 14 years earlier. In just hours, she recovered, becoming the first person in the world to be saved by an antibiotic. Rather than dying in her thirties, Mrs. Miller lived to be 90 years old.

"Today, decades later, germs like the one that infected Mrs. Miller are becoming resistant to antibiotics. You could have one in or on your body right now—a resistant germ that, in the right circumstances, could also infect you. But—unlike the bacteria that threatened Mrs. Miller—the bacteria may be able to avoid the effects of the antibiotics designed to kill them. Unfortunately, like nearly 3 million people across the United States, you or a loved one may face an antibiotic-resistant infection."

The use of antibiotics has a self-defeating element: the growth of genetically different bacteria and fungi that have mutated into forms that are resistant to the antibiotics or picked up resistance traits from other germs through mobile genetic elements. Also, antibiotic use encourages development of Clostridioides difficile, or C. diff., a bacterium "that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon," says the Mayo Clinic. The CDC report says 223,900 cases of C. diff. occurred in 2017, killing at least 12,800 Americans.

"Dedicated prevention and infection control efforts in the U.S. are working to reduce the number of infections and deaths caused by antibiotic-resistant germs, but . . . CDC is concerned about rising resistant infections in the community, which can put more people at risk, make spread more difficult to identify and contain, and threaten the progress made to protect patients," the CDC said in announcing the report. "The emergence and spread of new forms of resistance remains a concern."

What is to be done? "Public-health prevention programs targeting resistant germs can and have worked to slow spread and save lives, but more needs to be done," the report says. "The U.S. and global community must scale up these effective strategies and develop new strategies to prevent infections and save lives. In the United States, infection prevention activities have proven effective in slowing the spread of resistant germs. This includes:

• Strategies to decrease spread within healthcare settings (e.g., implementing hand hygiene)
• Vaccinations
• Implementing biosecurity measures on farms
• Responding rapidly to unusual genes and germs when they first appear, keeping new threats from spreading

Kentuckians use too many antibiotics; we're No. 1 in the nation, and a campaign has started to reduce inappropriate use

Kentucky has the highest rate of antibiotic use in the United States, and the University of Louisville School of Medicine is trying to do something about it.

The school's Department of Pediatrics has mounted a campaign to highlight the need for education and awareness on antibiotic overuse in Kentucky, and to reduce inappropriate use of antibiotics in the state.

“Although antibiotics are important life-saving drugs that treat bacterial infections – including strep throat and urinary tract infections – their overuse can lead to drug resistance, which occurs when antibiotics no longer cure infections that they should treat,” Bethany Wattles, a clinical pharmacist in the pediatrics department, said in a U of L news release.

“If we continue to overuse antibiotics, even minor infections will become untreatable. This is a serious public health threat,” Wattles said. “To combat the spread of antibiotic resistance, we must use antibiotics only when necessary.” 

The Kentucky Antibiotic Awareness campaign to health-care providers and the public is led by the department's Antimicrobial Stewardship Program, with support from the state Department of Medicaid Services, which finances health care for almost one-third of Kentuckians.

U of L researchers examined antibiotic prescriptions for Kentucky children on Medicaid and found that the rate of antibiotic use has been especially high in Eastern Kentucky. In some areas, children are receiving three times more antibiotic prescriptions than the national average.

"Antibiotics are most frequently used for upper respiratory infections, many of which are caused by viruses that antibiotics do not kill," the U of L release said. "The majority of antibiotic prescribing is done in outpatient settings, which include medical offices, urgent care facilities, retail clinics and emergency departments. Wattles said 30 to 50 percent of this antibiotic use is estimated to be inappropriate.

"When antibiotics are prescribed, it is important to take them as instructed; do not share the medicine with others or save for later use," the release says.

The campaign is on Facebook and Twitter. Health-care providers are encouraged to join the KAA Listserv for newsletter updates, or email KYAntibx@louisville.edu with questions and suggestions.

Most who think they're allergic to penicillin aren't; that can lead to over-use of antibiotics and resistant infections, a big issue in Ky.

About 10 percent of Americans say or think they have a penicillin allergy, but 90 percent of those people are not truly allergic and could tolerate the drug, according to the U.S. Centers for Disease Control and Prevention.

CDC graphic

The CDC says this misconception results in millions of people taking "broad-spectrum antibiotics," which are more expensive and also increase the risk of antibiotic resistance. That's a big deal because it puts a person at risk of being infected by a life-threatening "superbug" that can't be treated.

Superbugs are strains of bacteria that have become resistant to antibiotics and include infections like methicillin-resistant Staphylococcus aureus, which is commonly called MRSA, and Clostridium difficile-related colitis, or C.diff. Both infections can be deadly.

The CDC says every year, at least 2 million people are infected with antibiotic-resistant bacteria and of those, 23,000 die as a direct result of these infections. Kentucky has one of the highest prescribing rates of antibiotics and has led the nation in infection rates for MRSA and CRE (carbapenem-resistant Enterobacteriaceae).

So, it's important to find out if you are truly allergic to penicillin. The CDC encourages everyone who thinks they have an allergy to penicillin to talk to their health care provider in detail about their allergy, and to discuss whether or not they need an allergy test to confirm it.

A new study, published in the British Medical Journal, found that people with a penicillin allergy are nearly 70 percent more likely to get a MRSA infection and 26 percent more likely to acquire C.diff. The study looked at six year's worth of medical records from patients in the United Kingdom who were enrolled in the Health Improvement Network database.

“All of us need to understand that antibiotic use is not a free ride; it carries a lot of risk,” Paul Sax, clinical director of infectious diseases at Brigham and Women’s Hospital in Boston, told Kate Furby of The Washington Post.

Sax, who was not involved in the study, told Furby that the new study adds to the “substantial body of evidence” showing that a penicillin allergy has been linked to longer hospital stays and an increased risk of acquiring resistant infections.

Diagnosing a penicillin allergy can be challenging. Experts told Furby that while symptoms like rash, nausea and diarrhea could be signs of it, these symptoms could also "coincidentally occur" when someone is taking the drug; that children often get rashes that are mistaken for a penicillin allergies; and that even if children are diagnosed correctly, they can grow out of the allergy.

Kim Blumenthal, lead author of the study and assistant professor of medicine at Harvard Medical School, told Furby that people should examine their own medical records, and if it's been more than 10 years since the diagnosis, they should talk to their doctor about getting retested.

Blumental said: “I would want patients to think, ‘Hmm, am I really allergic to penicillin, or did my mom just tell me and it’s not really true, and should I get that evaluated?’”

Ky. leads nation in overuse of antibiotics, one reason for rise of drug-resistant bacteria; here's how to avoid serious infections

Dr. Kevin Kavanagh
(Lexington Herald-Leader photo)

An infection-control activist offers a dire warning about drug-resistant bacteria and offers tips on how to protect yourself from these deadly super-bugs in an op-ed piece for the Lexington Herald-Leader.

"There is a war going on, reminiscent of a zombie apocalypse," writes Dr. Kevin Kavanagh, who is also the board chairman of Health Watch USA. "The insidious agent is spread easily between people; a bite is not required. It does not turn its captors into mindless killing drones but instead, when they least expect it, they are slowly eaten from the inside out.The apocalypse is called drug-resistant bacteria, and so far, modern medicine is failing miserably at stopping it."

The federal Centers for Disease Control and Prevention reports that at least 2 million Americans are infected with a drug-resistant bacterium every year, and at least 23,000 of them die from it. There are signs that the problem will only get worse.

Kavanagh reports that some projections of the annual death toll from drug-resistant infections will reach tens of millions worldwide, surpassing cancer and heart disease as the leading cause of death. This has been widely written about, including stories from CBS News, BBC, Scientific America and STAT, to name a few.

Antibiotic resistance has been linked to the over-prescription of antibiotics; patients not finishing their entire antibiotic course; overuse of antibiotics in livestock and fish farming; poor infection control in health-care settings; poor hygiene and sanitation; and the absence of new antibiotics being discovered, Andrew Duong reports for InfectionControl.tips.

The overuse and over-prescription of antibiotics is a real problem in Kentucky. Kavanagh writes that Kentucky's antibiotic use is more than double the usage in other states and that the fluoroquinolone (Cipro, Floxin) class of antibiotics is prescribed at one of the highest rates, often inappropriately.

Centers for Medicare and Medicaid Services map shows  ZIP-code-level rates for antibiotics prescribed per 1,000 fee-for-service Part D Medicare beneficiaries in 2016. Dr. Kevin Kavanagh of Health Watch USA calls Kentucky the "bulls-eye of antibiotic overuse."

He adds that health-care providers have a responsibility to be the "gatekeeper[s] of antibiotic usage," but all too often "succumb to patient pressure."

"For most common illnesses, antibiotics are not effective," Kavanagh writes. "They will not work on viruses that cause the common cold nor on the flu. They will also not work on most 'sinus' infections."

Kavanagh adds details on how misuse of antibiotics can lead to a dangerous gastrointestinal infection caused c. diff (clostridium difficile), which is "almost impossible to get rid of" since it is not only resistant to many antibiotics but can transform into a spore that can remain inactive for years, only to reemerge when the body is in a weakened state.

"You know this is a bad actor when severe cases are being cured (and to a very high degree) by using a tube to place someone else’s feces into the patient’s GI tract," he writes. "Even the mention of this a decade ago would have been meet with ridicule and disbelief but 'desperate times call for desperate measures.' Lucky this one works."

Kavanagh offers these tips to protect yourself:

• Avoid the use of antibiotics whenever possible.
• Stay healthy, maintain good hygiene and get your vaccinations.
• When seeking health care, ask about a facility's MRSA (methicillin-resistant staphylococcus aureus) and c. diff rates, and any recent outbreaks of other dangerous bacteria.
• Check Hospital Compare, which offers information about the quality of care at over 4,000 Medicare-certified hospitals, to determine the facility’s track record on these measures.
• Kavanagh warns that a hospital's ability to handle these infections doesn't mean they are good at preventing them. He advocates for a "seek-and-destroy" methodology, similar to the one used by the Veterans Administration and England's National Health Service.
• If you are going for surgery and are not offered a test to see if you are a MRSA carrier, ask for one. If you are told it is not cost effective, he writes, "Remember it is a $10 preoperative test."
• Kavanagh notes that there is "solid evidence that MRSA preoperative screening is needed for most major surgeries" to determine which preoperative antibiotics are needed or if intervention is needed to prevent an infection, called decolonization.

Got a virus? You don't need an antibiotic but you might get one; Kentucky leads the nation in outpatient antibiotic prescriptions

Antibiotics don't cure illnesses caused by viruses, and can even cause "dire consequences" when used inappropriately, so it's important to take them only when necessary, says a news release from the state Cabinet for Health and Family Services.

"Antibiotics are the only drugs where use in one patient can impact the effectiveness in another patient," Andrea Flinchum, a registered nurse and coordinator for the Kentucky Department for Public Health’s Healthcare-Associated Infection Prevention program. "They are wonderful tools in fighting bacterial or fungal infections – but prescribing them for viruses or taking them for illnesses they do not treat, can cause bacteria to become resistant to these drugs."

Parents need to know that illnesses like the common cold, the flu, runny noses (even with yellow and green mucus), coughs, bronchitis, sore throats, most sinus infections and some ear infections are usually viral and antibiotics won't cure them, says the federal Centers for Disease Control and Prevention. In addition, antibiotics won't help your child feel better and won't keep others from catching your child's illness. Viral illnesses usually go away without treatment in a week or two.

The problem is that when your child takes an antibiotic when they don't need it it kills the good bacteria in your child's body, which can lead to complications, like diarrhea or yeast infections.

Overuse can also lead to bacteria developing resistance to a medication, making infections stronger and harder to kill. Sometimes these infections are so severe that they cannot be cured with antibiotics and thus require stronger treatments, and possibly hospitalization. The CDC estimates that each year 2 million Americans get an infection with antibiotic-resistant bacteria and every year 23,000 of those patients die.

The CDC estimates that more than half of the antibiotics given for upper respiratory infections and nearly a third of antibiotics used in hospitals are prescribed inappropriately. Kentucky has the highest prescribing rate for antibiotics in the outpatient setting in the U.S., Flinchum noted.

"It is critical to use these life-saving drugs when truly necessary, while also using the right drug at the right dose and duration to protect the effectiveness of antibiotics," said Flinchum. "We encourage clinicians to improve prescribing habits and patients to ask their providers if antibiotics are truly needed for their care."

Tips for smart antibiotic use:

• Don't insist on an antibiotic if your health care provider diagnoses your child's illness as a virus.
• Remember, antibiotics only treat bacterial infections.
• Some ear infections DO NOT require antibiotics.
• Most sore throats DO NOT require an antibiotic, unless it's strep throat.
• Green colored mucus is NOT a sign that an antibiotic is needed.
• Take as prescribed, not doing so can cause antibiotic resistant infections.
• Don't save half-used bottles of antibiotics for future use.
• Don't share antibiotics.
• Prevent infections by keeping your hands washed.
• Get a flu vaccine.
• If taking an antibiotic, call your doctor if you don't see improvement within three days.

Drug-resistant infections are a grave threat but are loosely monitored; Ky. health facilities must now report them electronically

By Melissa Patrick
Kentucky Health News

Antibiotic-resistant infections are considered one of the gravest threats to humanity, but such infections and the deaths they cause are not routinely reported, hindering the battle against them, Ryan McNeill, Deborah J. Nelson and Yasmeen Abutaleb report for the Reuters news service.

Reporting on their detailed investigation, they write: "Even when recorded, tens of thousands of deaths from drug-resistant infections – as well as many more infections that sicken but don’t kill people – go uncounted because federal and state agencies are doing a poor job of tracking them."

“You need to know how many people are dying of a disease,” Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy, a Washington-based health policy research organization, told Reuters. “For better or worse, that’s an indicator of how serious it is.”

The report noted many reasons such infections are omitted from death certificates, from poor training in how to fill out the forms to a reluctance of health-care facilities to mention them because "counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage."

The federal Centers for Disease Control and Prevention estimates that about 23,000 people die each year from 17 types of antibiotic-resistant infections and another 15,000 die from Clostridium difficile, a pathogen linked to long-term antibiotic use, but these numbers are "mostly guesswork" based on "few reported deaths from drug-resistant infection," Reuters reports.

Michael Craig, the CDC’s senior adviser for antibiotic resistance coordination and strategy, told Reuters that the agency settled on “an impressionist painting rather than something that is much more technical . . . because of our profound concern about the seriousness of the threat.” They said they are working to improve the estimates.

The numbers of uncounted deaths from drug-resistant infections “speak to what can happen when we don’t allocate the necessary resources to bolster … our public health safety network,” U.S. Sen. Sherrod Brown, D-Ohio, told Reuters. “When we see discrepancies in reporting, are unable to finance a workforce to monitor infections, and can’t even soundly estimate the number of Americans that die from [antibiotic-resistant infections] each year, we know we have a problem.”

Brown recently introduced a bill that would require the CDC to collect more and better data on superbug infections and death rates.

Wide variation in tracking

Reuters did a survey of the nation's health departments and found a wide variation in how seven leading superbug infections are reported, if they are at all.

It found that 17 states report C. difficile infections; 26 states report methicillin-resistant staphlycoccus aureus (MRSA); fewer than half report carbapenem-resistant Enterobacteriaceae (CRE), a family of pathogens that the CDC has deemed an “urgent threat;" and 24 states do not regularly track deaths due to antibiotic-resistant infections. "States that said they do track deaths generally do so for only a few types of drug-resistant infections, and not consistently," Reuters reports.

As of Oct. 1, a new regulation requires Kentucky health-care facilities to report a long list of drug-resistant infections to the Kentucky Department of Public Health electronically. The regulation also requires simultaneous data reporting to the CDC, and allows the agencies to share the data.

"This regulation on encouraging health-care facilities to report is extremely important to track these infections, to learn how to stop these infections and to identify problem areas in the state that need to be addressed," Dr. Kevin Kavanagh, an infection-control activist who leads the Somerset-based watchdog group Health Watch USA, said in a telephone interview with Kentucky Health News.

Kavanagh said proper reporting will allow examination of the methods health-care facilities use to fight these infections and determine whether they are effective or not. He called the matter a "huge, huge issue in nursing homes."

In the Reuters survey, U.S. health departments reported about 3,300 deaths from drug-resistant infections in 2003-2014, but the news service's own analysis of death certificates found 180,000 such deaths during the same time period. More than 20,000 were in California and more than 5,000 were in Tennessee, both states that do not require reporting of deaths linked to such infections.

Reuters found that Kentucky health departments only reported nine deaths related to health care acquired infections between 2003-2014, but Reuter's investigation found 3,027.

Patient-safety advocates petitioned the CDC in 2011 to add a question about hospital-acquired infections to its standard death certificate, which is used by many states, and have been told that it will be considered the next time the CDC revises its certificate.

Little progress made

Over-prescription of antibiotics and their overuse in farm animals has worsened antibiotic-resistant infections. Also, more people are living with weak immune systems and spending more time in health-care facilities, where most most of these infections occur.

Kavanagh said better reporting could indicate whether the overuse of antibiotics in agriculture plays a large part or a small part in the problem.

Reuters reports that in 2001, a task force led by the CDC, the Food and Drug Administration and the National Institutes of Health declared antibiotic-resistant infections to be a grave public health threat and issued an action plan to tame the problem. The plan included creating a national surveillance program and speeding the development of new antibiotics. But little progress has been made toward these goals.

A new national plan to combat this problem was introduced in 2014. Congress followed in 2015 with "a $160 million increase in the CDC’s budget to bolster research, drug development and surveillance of superbugs by the states," Reuters reports. But the news service found that states often come up against strong institutional resistance and laws that shield the health-care industry when it comes to surveillance.

Bacteria that can't be treated by any antibiotic now in U.S.; Kentucky ranks first in one type of antibiotic-resistant infection

A colorized scanning  of E.Coli
Credit: CDC/Jancie Haney Carr

For the first time, researchers have found a person in the United States carrying bacteria that can't be treated by "last resort" antibiotics.

The antibiotic-resistant bacteria found in the 49-year-old Pennsylvania woman's urine was from a strain of E.coli bacteria that is resistant to an antibiotic called colistin, a last-resort drug with serious side effects that is used only when other antibiotics don't work.

For example, colistin is used to treat the superbug carbapenem-resistant Enterobacteriaceae, commonly called CRE, which health officials call a "nightmare bacteria."

Nearly half of patients who become infected with CRE die from it, Lena H. Sun and Brady Dennis report for The Washington Post.

The Pennsylvania woman was able to be treated with other antibiotics, but the discovery of the colistin-resistant strain has placed health officials on alert.

Health officials say it's not time to panic, but there is great concern that this colistin-resistance gene could spread to other bacteria that are also antibiotic-resistant creating many more bacteria strains that are untreatable, reports the Post.

The colistin-resistant strain was first found in pigs, raw pork and a few people in China in November. It has also been found in Europe.

“It basically shows us that the end of the road isn’t very far away for antibiotics — that we may be in a situation where we have patients in our intensive care units, or patients getting urinary-tract infections for which we do not have antibiotics,” CDC Director Tom Frieden told the Post.

Separate research found that the same colistin-resistant strain was found in a sample from one pig intestine in the United States. Colistin is widely used in Chinese livestock, but is not used in the United States, though plenty other antibiotics are, Tom Philpott reports for Mother Jones.

"Around 80 percent of the antibiotics sold in the United States go to livestock farms, and of that, 60 percent are considered crucial to human medicine," Philpott writes. Farmers mostly use antibiotics to help their livestock grow faster.

Yohei Doi, an infectious-disease doctor at the University of Pittsburgh, told the Post that he thought the widespread use of the antibiotic in Chinese livestock is likely what has led to the bacteria evolving and gaining resistance to the drug, and then leaping from livestock to humans through food.

Dr. Kevin Kavanagh, a retired physician and chairman of HealthWatch USA, said he isn't convinced that the U.S. pig was infected by livestock from China. He noted that colistin is commonly used to treat CRE, cystic fibrosis and that a form of colistin can be found in many over-the-counter topical antibiotics.

"It's probably more likely that the pig in the U.S. obtained this from the farmer's medicine cabinet than from another pig in China," Kavanagh said.

Experts in infectious diseases have called for action to curb the overuse of antibiotics in livestock worldwide. They have also warned that if these antibiotic-resistant bacteria continue to spread, treatment options could be severely limited.

Kavanagh  recognized the importance of research around the overuse of antibiotics in livestock but said that he thought more emphasis should be placed on the human side of healthcare related to antibiotic-resistance bacteria than the agriculture side of it.

 "The foremost emphasis should be placed on controlling antibiotic usage, controlling the spread of these organisms and surveillance of these organisms. ... We don't really know how many infections exist because we have a fragmented reporting system, but you know how many cows there are in each county," he said.

The federal Centers for Disease Control and Prevention estimates that at least 2 million people are infected with antibiotic-resistant bacteria each year, and 23,000 die.

Kentucky ranked first in MRSA cases, July 2014 - June 2015.

HealthWatchUSA

Kentucky has one of the highest prescribing rates of antibiotics in the nation and also leads the nation in another antibiotic resistant infection called MRSA (methicillin-resistant staphylococcus areus).

"Overuse of antibiotics has got to stop," says Kavanagh said. "The use of antibiotics needs to be curtailed to only when it is necessary. ... Every time you take an antibiotic you remove your good bacteria and run a real risk of activating a superbug in your body which can cause you extreme harm and even death. You should only take antibiotics when you have to take them."

Pharmaceutical companies have stepped away from developing new antibiotics because they aren't very profitable. But William Schaffner, medical director of the National Foundation for Infectious Diseases, told WebMD, "The Infectious Diseases Society of America has been working with Congress and with industry to create incentives for the pharmaceutical industry to reopen its antibiotic research laboratories."

In addition, "Late last year, as part of a broader budget deal, Congress agreed to give hundreds of millions of dollars to the federal agencies engaged in the battle against antibiotic-resistant bacteria," reports the Post.

New rule will improve reporting of antibiotic-resistant infections in health-care facilities, which are getting worse in Kentucky

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — Kentucky will have a new weapon, in the form of data, to fight infections acquired in hospitals and other health-care facilities, with legislative approval of a regulation that changes the way antibiotic-resistant infections such as MRSA and C. difficile are reported.

Health Watch USA chart, Centers for Disease Control data

The new rule comes at a time when Kentucky has the third highest rate of MRSA bloodstream infections in the nation, according to the National Healthcare Safety Network. The state was ranked fourth last year.

Kentucky hospitals are 27 percent worse for MRSA (methicillin-resistant Staphylococcus aureus) and 21 percent worse for catheter-associated urinary tract infections than they were two years ago, according to the federal Centers for Disease Control's National and State Health-care Associated Infection Progress report.

The legislature's Administrative Regulation Review Subcommittee approved the regulation, which has been in the works since 2008, at its Jan. 13 meeting. In the meantime, hospitals have succeeded in changing the term "hospital-acquired infections" to "healthcare-associated infections" to indicate that not all such infections occur in hospitals.

"The emergence of these dangerous organisms is really a problem of our entire heath care system and it can't be fixed by any single facility or facility type," Kevin Kavanagh of Somerset, chairman of Health Watch USA, a non-profit organization that promotes health care transparency and patient advocacy, told the committee. For his testimony, click here.

The regulation redefines HAIs and HAI outbreaks for infections, and requires simultaneous data reporting to the CDC and the state Department for Public Health. The CDC already has the data, but has "no authority" to act on it, while the state health department has the authority but not the data, Kavanagh wrote in an opinion piece for the Lexington Herald-Leader. "It is imperative that we know what is happening and where, so effective action can take place."

He told the committee, "Data for action is critical. It is the first step to confront these dangerous organisms."

The regulation also will require electronic reporting via the Kentucky Health Information Exchange beginning 2016. It now goes to Gov. Steve Beshear for final approval, which is expected.

Rep. Tom Burch, D-Louisville, chair of the House Health and Welfare Committee, told the joint House-Senate regulations committee that he had worked on the regulation for many years and that the Kentucky Hospital Association supported it. It had lobbied against such regulations. "There is nobody against it right now," Burch said.

However, Sen. Alice Forgy Kerr, R-Lexington, said "This regulation seems to have caused a lot of indigestion for a lot of people," and asked for a "statement of confirmation" from someone representing a group that might have opposed it in the past.

The hospital association's vice president of government relations, Sarah Nicholson, was at the meeting but didn't speak. Dana Stephens, director of infection prevention and control at St. Joseph East Hospital and St. Joseph Jessamine, told the committee, "I have had the great pleasure and honor of working with this multidisciplinary team for the past many years to really develop legislation and regulatory language that will provide information that will improve the health of those citizens we serve."

Kerr commended the groups on reaching a compromise, but the elements of the compromise were unclear. Nicholson declined to comment after the meeting.

Kavanagh said afterward that the regulation is needed to reverse the apparent increase in hospital infections, based on the CDC data from 38 of the state's 93 hospitals. "We are going in the wrong direction, with Kentucky 27 percent worse than it was two years ago," he noted. "This regulation will help with that."

Centers for Disease Control graphic reports Kentucky data on health-care-associated infections

The regulation is expected to improve the accuracy of Kentucky's HAI data because it requires all health-care facilities to submit reports and more clearly defines HAIs, which Kananagh said will help with under-reporting of infections.

New regulations often raise questions about the cost of enforcing them. Kavanagh told the committee that the CDC had told him that it would be allocating "a lot of federal money" to state health departments through grants to confront infectious disease issues, a result of the lessons learned from Ebola. Better HAI data will support Kentucky's need for these grants, he said.

"So, I do believe the state health department, along with other entities, will have access to funds to implement this regulation change,” he said.

'Superbug' considered the worst one yet is still not widespread in Kentucky hospitals, but officials predict it is coming

A new deadly superbug that is almost totally resistant to antibiotics and kills about half who get bloodstream infections has found its way to community hospitals in the Southeastern United States, Laura Ungar reports for The Courier-Journal.

 "We haven't seen much here, but I'm sure it's coming," Forest Arnold, an epidemiologist at University of Louisville Hospital and an associate professor of infectious diseases at the university, told Ungar.

CRE, short for carbapenem-resistant Enterobacteriaceae, are a family of bacteria that have, over time, become resistant to antibiotics called carbapenems, which are considered drugs of last resort for this type of infection. It can cause a range of illnesses depending on where it infects the body, ranging from gastrointestinal illness to pneumonia to bloodstream infections.

A recent study in the journal Infection Control and Hospital Epidemiology indicates CRE increased "fivefold" at community hospitals in several southeastern states from 2008 to 2012, Ungar reports. Kentucky was not part of the study, but researchers say the rates "reflect a growing problem across the region and throughout the country." 

"People need to be aware," Arnold told Ungar. "It will eventually get here."

Experts report that overuse of antibiotics is one of the main reasons for these superbugs, Ungar writes. And Dr. Kevin Kavanagh, an infection-control activist who leads the Somerset-based watchdog group Health Watch USA, told Ungar that  Kentucky has one of the nation's highest rates of antibiotic use, sometimes prescribed unnecessarily.

"CRE is very dangerous," Kavanagh said. "It is almost totally resistant to antibiotics."

Ungar reports that local hospitals have seen growing numbers of CRE, citing examples of University Hospital with a case last year in which the patient died, and Norton Healthcare, with three cases in the first three months of last year and 10 others between 2010 and 2013.

Last year, the federal Centers for Disease Control and Prevention warned that CRE had spread from one medical facility in 2001 to numerous facilities in 46 states in 2013, Ungar notes. CDC Director Tom Frieden has labeled  CRE "nightmare bacteria," calling them the worst of the growing list of antibiotic resistant germs that "take hold in health care settings."

 One in 25 hospitalized patients has at least one health care-associated infection on any given day, according to the U.S. Centers for Disease Control and Prevention, with C. difficile, which causes 14,000 American deaths per year and MRSA, which one study shows kills 18,000 Americans a year, being  two of the most common, Ungar reports.

Doctors say they hope to control CRE before it becomes as common as MRSA, which has spread to communities, Ungar reports.

 "So far, CRE are just in the health care setting," Kavanagh told Ungar. " 'If it continues to grow and escape into the community, it will be an even bigger problem' and the medicines doctors count on to cure bacterial infections will no longer work against them."

Kavanagh told Ungar that "antibiotics should be used only when they are absolutely necessary, and hospitals must remain vigilant about ensuring health care workers wash their hands often, keep rooms and medical equipment clean, wear gowns and gloves when appropriate and separate infected patients from others."

"If the emergence and spread of superbugs aren't prevented,'we'll be in a post-antibiotic era'," Kavanagh told Ungar. "And the danger is not going to go away unless we change the course of how we do things."

Prescribing antibiotics for viral infections must stop; overuse of antibiotics causes antibiotic-resistant 'superbugs'

Bronchitis is a viral infection, and antibiotics are not effective for treating viral infections.

Doctors know this, yet they continue to prescribe antibiotics to patients with bronchitis and other viral infections anyway, Ezra Klein reports on his new website, Vox.

Research shows that doctors prescribe antibiotics for acute bronchitis about 71 percent of the time even though they know that overuse of antibiotics is the leading cause of "superbugs," or organisms that are resistant to some if not all antibiotics, Klein reports. They do this because it makes patients feel better to walk out of the doctor's office with a treatment.

Klein goes on to paint a picture of a post-antibiotic future that could result from doctors prescribing antibiotics for viral infections. Klein reports that  patients must stop thinking that good physician care is the result of being treated with an antibiotic, especially in the treatment of bronchitis.

Kentucky and its Southern neighbors overuse more than their share of antibiotics.  The southeastern states are the highest users of antibiotics, with twice as many antibiotic prescriptions as states in the Pacific region, according to a study by the Center for Disease Dynamics, Economics & Policy, part of the federal Centers for Disease Control and Prevention.

CDC recommends that every hospital in this country have an antibiotic stewardship program and track their resistance and prescribing patterns. Half of all hospital patients get antibiotics and one-third of the antibiotics prescribed are inappropriate or are unnecessary, CDC Director Tom Frieden told Klein.

Frieden said the world is at risk of losing antibiotics to resistance created by over-prescribing, but a "modest investment" can thwart the most dangerous drug-resistant organisms. Working toward creating new antibiotics and then not falling into the same patterns of abuse must also be part of the solution, Frieden said. (Read more)

Kentucky is No. 1 state in overuse of antibiotics, a problem that poses wide dangers to the drugs' effectiveness

In 2010 the average number of dispensed outpatient antibiotic
prescriptions was 801 per 1,000 Americans. In Kentucky it was
1,197. The darker the state, the higher the rate. (CDC map)

Americans, especially Kentuckians, are taking too many antibiotics and that is contributing to the decline in the drugs' effectiveness, says a study by a group associated with the Centers for Disease Control and Prevention.

The study found that, in 2010, the five states with the highest antibiotic use were Kentucky, West Virginia, Tennessee, Mississippi and Louisiana. Such misuse is already showing up, reports USA Today, as lab reports show urinary tract infections were 30 percent more likely to resist antibiotic treatment in 2010 than in 1999.

Dr. Robert Salley, executive director of cardiovascular services for KentuckyOne Health in the Lexington market, told Cheryl Truman of the Lexington Herald-Leader that the overuse of antibiotics might reflect the state's problem with prescription pain pills. Many Kentuckians are used to "that culture of availability, that culture of not making appropriate use of the physician-patient relationship," he said. Experts have also noted that states that have lower rates of antibiotic use have spent money and time educating their residents about the dangers of overuse. Kentucky has not done that. (Read more)

Meanwhile, the Pew Health Group has released a study showing that 87 percent of Americans have a basic understanding of what antibiotics do, but many did not understand that antibiotic resistance was a major health issue and will only become more problematic in the future. Forty-one percent of Americans said they have never heard of the issue. For more information on that study, go here.

Use of pacifiers could lead to very sick babies, study finds

Oklahoma State University researchers report that they have found a wide range of disease-causing bacteria, fungus and mold on pacifiers that young children had been using.

In research presented at the American Society for Clinical Pathology, scientists have shown that pacifiers can also grow a slimy coating of bacterial film that alters the normal bacteria in a baby or toddler's mouth, increasing the likelihood of colic and ear infections. It gets worse, according to study author Tom Glass, a professor of forensic science, pathology and dental medicine: The same types of bacteria found on a common pacifier have been linked to cardiovascular disease, metabolic syndrome, allergies, asthma and autoimmune diseases.

HealthDay reporters Barbara Bronson Gray writes that Glass said the problems associated with pacificers are also applicable to any removable orthodontic appliance like retainers, mouth guards and dentures. Glass said his researchers were particular concerned about their findings when they discovered that "many of the bacteria growing from the used pacifiers were resistant to commonly used antibiotics such as penicillin and methicillin. The development of such resistance to certain antibiotics does not cause the organism to be more infectious than other strains that have no antibiotic resistance, but it can make the infection more difficult to treat." Glass told Gray that he does not recommend that pacifier use. use. "After doing the study, I say why take a risk?" (Read more)

Kentucky second highest in antibiotic consumption in U.S.

The next time you ask your doctor for an antibiotic, or if he or she offers to give you one, think again. It might do your health no good, but could be bad for public health.

"Every time an antibiotic is used ... future effectiveness of that drug is diminished," but Kentuckians take antibiotics at the second highest rate in the country, with 1,205 prescriptions per 1,000 people, says a study by the Centers for Disease Dynamics, Economics and Policy. Only West Virginia had a higher rate, 1,214 per 1,000. 

Studies show 1 million antibiotics are prescribed unnecessarily every year. "Though antibiotics offer no benefits for colds and other viral infections, many people, including doctors, continue to view these drugs as a quick fix," said a press release by the Robert Wood Johnson Foundation, which helped fund the study.

The problem with the overuse of antibiotics is that bacterial infections become resistant to them. To illustrate the issue, CDDEP says, "High-level penicillin resistance in Streptococcus pneumonia in the United States has experienced a thousand-fold increase in the last 20 years," rising from 0.02 percent in 1987 to more than 20 percent in 2004. The prevalence of methicillin-resistant Staphylococcus aureus — known more commonly as staph — increased from about 2 percent in 1974 to 50 percent in many U.S. hospitals in 2004.

"The problem of resistance is an evolutionary game played between humans and microbes: we try to stay ahead by creating new antibiotics, and microbes develop resistance to our drugs," CDDEP reports. "Unfortunately for us, microbes evolve resistance to antibiotics faster than we can create new drugs, meaning that, in recent years, bacteria have been winning this 'arms race.'"

Though there is no cure to resistance, managing the levels at which people become resistant is possible through judicious prescribing, vaccination, hospital infection control, treatment strategies and new antibiotics. (Read more)