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Introduction
Shortly after the introduction of the parent antibiotic penicillin to clinical practice, a report came for bacteria becoming insensitive. These were the earliest reports of bacterial resistance to antibiotics. These reports were not considered significant as lab studies displayed that such resistance can be overcome by increasing the dose. Because of the appearance of AIDS in the medical arena in 1981, all healthcare workers became increasingly aware of the problem as they had to deal with decreasing numbers of antibiotics because of antibiotics resistant bacterial strains (Cloutier, 186, 187).
Antibiotics are chemical substances that are either produced naturally by a microorganism or developed synthetically to kill pathogenic microorganisms by interacting with specific targets (cell membrane, mitochondria, or another microorganism cellular structure). Thus, antibiotic resistance points to the ability of a microorganism not to be affected by an antibiotic. This represents a clinical problem in treating everyday infections or more seriously in managing infections in a specific hospital setting as the ICU, pediatric unit, or hospital-acquired infection (LeJeune, p. 1).
As antibiotic abuse is a major risk factor in developing bacterial strains resistant to an antibiotic, Wester and others (Pp. 2210-2216) surveyed 490 internal medicine physicians about the importance, knowledge of prevalence, and self-reported experience of antibiotic resistance. Their results showed that almost all physicians included are aware of how serious the problem is. However, their attitudes as to how to solve the problem and its possible causes are varied. This may impose difficulty on the efforts of improving prescription and infection control strategies.
Main body
Multidrug-resistant organisms (MDROs) are bacteria resistant to one or more classes of antibiotics. These include methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE), certain gram-negative bacilli including B-lactamase producers, E.Coli, and Klebsiella pneumonia, besides some species of Burkholderia and Stenotrophomonas, which are intrinsically resistant to broad-spectrum antibiotics.
The severity and extent of antibiotic-resistant bacterial infection vary according to the pathogen producing the infection and to healthcare institutions and facilities where infection occurred (ICU, neonatology, or burn unit). Thus, prevention and control measures have to be designed specifically in accordance to meet the needs of the healthcare facility and population affected (Siegel and others Pp.4-6).
Dziedzic and others (Pp. 11-21) suggested two main aspects to the biology of bacterial antibiotic resistance; these are the development and possession of the resistance gene (genetic features), and biochemical mechanisms (biochemical features). Genetic features include mutations (spontaneous, hypermutators, and adaptive mutagenesis) which may occur at the transcription or translation levels, and horizontal gene transfer through plasmids, conjugative transposons, and integrons.
Biochemical features, on the other hand, include antibiotic inactivation by hydrolysis, group transfer, or redox processes, target modification, and target bypass are alternative biochemical features. The design of proper antibiotic-resistant bacterial infections prevention and control strategies needs to apply epidemiological approaches and the research technologies targeted at the mechanisms of developing resistance (Dzidic and others Pp. 11-21).
Smith and others (Pp. 1-16), suggested that infections with antibiotic-resistant bacteria have specific medical, social, and ethical characteristics. First, these infections usually have higher morbidity and mortality. Second as infectious diseases are caused by invasion or attack on humans by pathogenic microorganisms. Infections with antibiotic-resistant bacteria are specifically greatly persistent and invasive.
Infections with these organisms are rapidly progressing (show more acuity in course), and more communicable, rapidly transferred from one person to another. These infections are difficult to treat and may need further bacteriological and antibiotic sensitivity testing. They are also difficult to prevent because of changing epidemiological, and infection behavior patterns. Host susceptibility and general resistance is a crucial factor in the pathogenicity of these organisms.
Vulnerable patient groups (ICU, Post-surgery, and neonates are particularly prone to this infection), which is one reason for increased morbidity and mortality of these infections. These infections have a higher socioeconomic impact because of the expense of treatment, difficult prevention, and quickly spread. Emerging antibiotic-resistant bacterial infection as Multidrug-resistant tuberculosis, West Nile Virus infection, SARS represent community public health serious problems.
Sack and others (Pp. 1-51) reviewed antibacterial resistance in bacterial enteric pathogens, namely Vibrio cholerae, Shigella species, and Campylobacter jeujeni. About V. Cholerae, they inferred that antibiotic resistance occurred through plasmids acquisition, with resistant strains causing epidemics. The suggested that the problem is antibiotics resistance patterns of this bacterial species changes both temporally, and geographically.
This calls for persistent surveillance as susceptible strains occasionally reappear as antibiotic pressure is taken off. This makes cholera one of the diseases where reversion to sensitivity occurs when antibiotic use is properly controlled. Shigella species represents the most serious challenge, because of the tendency of steadiness of trends towards multiple antibiotic resistance. Further once the organism becomes resistant epidemic and endemic Shigella strains remain resistant.
Also, prevention is difficult as a small number of the organism is all that is needed to produce infection. In which case, water and sanitation health programs, as well as vaccine development, may produce an impact on prevention. Over the past 25 years, Campylobacter jejuni has advanced from being a newly discovered pathogen to be the most significant pathogen for diarrhea in the developed countries particularly in children and travelers.
It causes endemic diarrhea as well as diarrhea outbreaks. Further, the organism is blamed to be a common cause of Guillain-Barre syndrome. The mechanism of pathogenicity is not yet fully known, which makes future molecular pathogenicity research of importance in prevention through developing vaccines and management. Uwaezuoke and Aririatu (Pp.67-69) studied the antibiotic resistance of Staphylococcus Aureus.
Their results showed that in 48 Staph aureus isolates, 95.8% were resistant to penicillin, 89.6% were resistant to ampicillin, 87.5% were resistant to tetracyclines, and 75% were resistant to chloramphenicol. The organism was highly susceptible to gentamycin 91.5% and cloxacillin 85.4%. They explained their results in the lights of prevailing use and abuse of the antibiotics the organism is resistant to.
Antibiotic-resistant pneumococci were studied by Schrag et al (Pp. 1-30). Streptococcus pneumonia is the principal pathogen of acute respiratory tract infection which is a leading cause of morbidity and mortality especially in children and compromised patients with a low general resistance. Epidemiological studies show that recent antibiotic use is associated with developing resistant pneumococci both on an individual level, and community level.
Although the biological mechanisms are not fully illustrated, yet it is known that unnecessary antibiotic use for viral respiratory tract infections is a key factor in developing pneumococcal resistant strains. It is also documented that pneumococcal resistant strain can be developed as a result of drugs used for unrelated conditions. This casts a shadow of doubt on mass antibiotic campaigns to eliminate diseases as trachoma adopted in some developing African countries. Since pneumococcal polysaccharide vaccine is the established prevention practice. It should be remembered that it is effective only against bacteremic pneumococcal pneumonia, and has no impact on pneumococcal carriers. Further the vaccine is not recommended for children of two years of age or less.
Tuberculosis is a serious disease caused by Mycobacterium tuberculosis that is indigenously resistant to common antibiotics. Prakash (Pp. 17-18) in his review on tuberculosis and antibiotic resistance estimated that there are 8 million new TB infections every year.
The main problem is the resistance toward traditional antituberculous drugs isoniazid, Rifampicin, and streptomycin with a ratio of 65% to 12% of resistant strains. This created the problem of increased infectivity as 31% of infected surviving patients are inadequately treated and have active infections. This makes spread when suitable community ecological conditions exist (as in India, some underdeveloped African and Asian countries) a near epidemic status.
BA de Moraes and others (Pp. 387-394) studied antibiotic resistance of pseudomonas aeruginosa in a neonatal ICU. Their results showed that 62.5% of cases infected with antibiotic-resistant Pseudomonas aeruginosa received empirical antibiotics before the results of blood culture. All resistant strains isolated were classified as Multidrug-resistant pathogens with a high percentage of B-lactams, chloramphenicol, and sulpha combination.
Intensive care units patients are 5 to 10 more susceptible than other hospitalized patients to acquire a nosocomial infection. Because of the complexity of the cases, increased possibility, and risks of invasive interferences, antibiotic-resistant bacterial infections are expected to produce a greater impact on morbidity and mortality. Prevention and control strategies of nosocomial infections in the ICU have focused on MRSA, B-Lactamase producing gram-negative bacilli, and vancomycin-resistant enterococci (Weber and others Pp. 34S-41S).
Weber and others (Pp. 34S-41S) suggested the following protocol for antibiotic-resistant bacterial prevention and control in the ICU clinical setting. It is composed of general measures as the availability of a surveillance system to identify an outbreak, besides a protocol for proper intervention and evaluation. Sticking to the basic infection control procedures like hand washing, disinfection and sterilization should minimize the risks. They showed that hospital areas with the highest antibiotic use show the highest prevalence of antibiotic-resistant nosocomial infections. Therefore, they stressed proper antibiotic use following the standard guideline (Weber and others Pp. 34S-41S).
The keys to the prevention and control of antibiotic-resistant bacterial infections are threefold. First are administrative measures as this should be a health institution aim not for a particular unit but the whole institution. Such measures can be the presence of an administrative member in the infection control committee, the presence of a comprehensive infection control plan, and the provision of educational programs and tutorials to the staff on antibiotic-resistant bacterial infections. Second is the cautious policy of antibiotic use in all departments. Third, is a system of surveillance with adequate tools for decolonization and application of infection control procedures once an outbreak threatens (Wisconsin Division of Public health Pp. 2- 19).
Conclusion
Antibiotic-resistant bacterial infection is a growing public health problem. Many of the antibiotics that were considered effective (as vancomycin, ampicillin, and tetracyclines) are now ineffective against resistant bacterial strains new medications carry the hope to properly treat these cases. Examples are glycopeptide class medications as oritavancin, immunotherapeutic medications and vaccines have their place in prevention and prophylaxis during outbreaks (Fowler Pp.1-3).
Facing this public health problem is multifaceted and needs work on many fronts; the antibiotic use in the agricultural business and veterinary medicine has to be regulated, Federal agencies (the FDA) have to examine methods and recommendations for proper antibiotic use. There should be a continuous medical education program for medical, nursing, and paramedical personnel as to the risks of improper use of antibiotics and the guidelines for proper use. There should be contact with the general public as to the volume of the problem and how serious it can be (Taraporewala Pp.6-11).
Works Cited
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