Be proactive to help stop the spread of antibiotic resistance

Dr. Lynora Saxinger

November 2011

Many Canadians are alarmed when they find out that they or a loved one have been in contact with a hospital “superbug,” like MRSA (methicillin-resistant Staphylococcus aureus) or Clostridium difficile. Questions about the danger, preventing the spread and what to do once you leave the hospital are common.  

Once someone has been in contact with a carrier, they are put in isolation and tested. Testing positive does not mean they are, or will get sick from that bug; they may be one of the 25 per cent of people who carry the Staph bacteria on their skin or in their nose, and they happen to carry a strain that is resistant to some common antibiotics. 

Carrying this resistant strain does mean you might get an infection, but most people do not. Staph infections commonly involve the skin, operative incision sites and wounds. Knowing you carry it is useful, because if you get symptoms of infection, you are more likely to be put on the right kinds of antibiotics quickly.

Carriers usually remain in isolation in hospital to prevent spread of the germ. Once home, ordinary cleanliness is recommended—frequent hand-washing, keeping wounds covered and avoiding sharing towels. 

Carriers are not usually a risk to their loved ones with casual contact. However, a newer strain of MRSA called community associated MRSA is a little more likely to cause skin infections. If someone has had boils or “spider-bite” skin infections from MRSA, close contacts should be swabbed for MRSA if they get similar skin infections. 

Doctors may attempt to reduce or eliminate the bacteria from the nose and skin by “decolonization” with skin antiseptics and antibiotics.

Clostridium difficile colitis, or “C. diff” is a type of diarrhea usually caused by the overgrowth of a diarrhea-causing bacteria.

This is usually because of an imbalance caused when taking antibiotics reduces the good bacteria in the gut. People may carry C. diff spores for a long time, and spores can be spread by surfaces in bathrooms and hospitals. 

Some people get better when they stop taking the antibiotic and their good bacteria help rebalance their colon’s function, but many need an antibiotic treatment. Diarrhea has a tendency to recur, so anyone who has had C. diff should get tested quickly if it comes back.

Isolation precautions are meant to reduce the spread of resistant organisms in the hospital environment.

Often, this means wearing gowns over street clothes, gloves and sometimes masks. Gloves are not a substitute for hand-washing. Hand-washing (or using alcohol-based hand rubs) by health-care workers, patients and visitors is the most important way to reduce spread of resistant organisms. 

People often feel bad, or “dirty” when in isolation, but there should be no need for that; the precautions are a fact of life in modern hospital care.

Lynora Saxinger BSc, MD, FRCPC, CTropMed, is chair of the Antimicrobial Stewardship and Resistance Committee, Association of Medical Microbiology and Infectious Disease (AMMI) Canada, and associate professor, Divison of Infectious Diseases, Departments of Medicine and Medical Microbiology and Immunology, University of Alberta Hospital.

Bacteria that are resistant to common antibiotics are on the rise worldwide because of improper use of antibiotics, and some of these bacteria thrive and spread in hospital environments. Up to 50 per cent of antibiotics used in hospitals are given unnecessarily.

To avoid the rise of nearly untreatable infections, we need to make sure we take antibiotics only when needed and as prescribed. Doctors sometimes feel that patients will be disappointed if they don’t receive an antibiotic, even when symptoms are probably from a viral infection.

Patients can help by mentioning to their doctor that that if their ill- ness is probably viral, they’d appreciate advice on non-antibiotic management and information on when they should come in for reassessment for antibiotics.

Patients can ask to talk to their physician or infection control practitioners for more information.

November 14 to 20 is Antibiotic Awareness Week and several Canadian health-related organizations are working to promote the prudent use of antibiotics. For information on what you can do to help stop the spread of antibiotic resistance, visit antibioticawareness.ca