Antibiotic Resistance
SWIFT - Antimicrobial Stewardship Program (Pharmacy) - Useful Tools
Antibiotic Surgical Prophylaxis Guidelines - Adults
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What is antibiotic resistance?
Antibiotic resistance is what occurs when bacteria or fungi develop the ability to survive the antibiotic medications that would previously kill them. These medications would usually either kill the pathogens or stop them from growing. However, pathogens that are developing antibiotic resistance can withstand the effects of certain antibiotics.
Antibiotic resistance makes infections very difficult to treat because there are fewer drugs that can kill the pathogen. Often, infections caused by antibiotic pathogens, such as MRSA, require more extended hospital stays to treat due to the time it may take to figure out what drugs will successfully eliminate the pathogen.
How does antibiotic resistance occur?
Bacteria and fungi exist everywhere, including on your skin. Most bacteria and fungi are actually helpful, and do not cause any harm while some bacteria and fungi can make us sick.
As pathogens reproduce, they can occasionally develop mutations - some of these mutations that pathogens acquire are what can cause antibiotic resistance. For example, when an antibiotic is administered to fight a bacterial infection, it kills all of the non-resistant bacteria and leaves only those that are resistant behind. These resistant bacteria then have no competition for material needed for their survival which then allows them to multiply rapidly and confer resistance to their offspring. Some bacteria are also able to spread antibiotic resistance directly to other bacteria without multiplying. Because of bacteria’s ability to rapidly multiply and spread between themselves, antibiotic resistance can spread very rapidly once it has occurred.
Antibiotic resistance is more likely to spread when antibiotics are used without restraint, as mutations conferring resistance are more likely to occur with more incidents of antibiotic use. Sometimes antibiotics are given to patients who are sick with a disease that will not be fixed with the use of antibiotics. These include illnesses caused by viruses, which are pathogens that can look very similar to illness caused by bacteria but cannot be killed by antibiotics. The administration of antibiotics to someone who is sick with a virus will not resolve their illness, but may increase the spread of antibiotic resistance.
How are antibiotic resistance and healthcare-associated infections related?
The ability to rapidly multiply despite antibiotic administration allows antibiotic resistant pathogens to rapidly multiply in settings where the use of those products is common place. As such, hospitals are a location where antibiotic resistant pathogens can be found frequently.
The presence of antibiotic resistant pathogens at hospitals increases the risk of patients being developing an infection from these pathogens. Additionally, patients at hospitals who are already be sick or have a compromised immune system have an increased risk of contracting an infection. Since these pathogens are resistant to antibiotics, a patient who is being treated for an infection caused by antibiotic sensitive pathogens can still be infected by their antibiotic resistant counterpart.
What is antibiotic stewardship and why is it important?
Antibiotic stewardship is the concept of reserving the use of antibiotics for patients that have been confirmed to have a disease caused by a pathogen that will respond to antibiotics. Another important aspect of antibiotic stewardship is reliant on patients completing their course of antibiotics so that all bacteria are killed off and none are left to develop resistance.
Enacting hospital policies which adhere to antibiotic stewardship are effective in decreasing the spread of antibiotic resistance as well as ensuring the full resolution of a bacterial infection.
Practices that respect the principles of antibiotic stewardship include only using antibiotics that have specific coverage of a pathogen while opting against using broad-spectrum to treat an infection, and relying on the cultures and antibiotic sensitivities of a specific pathogen to guide treatment.
How can I stay updated on trends on antibiotic resistance in the community and within the healthcare system?
Many hospitals have an antibiogram which shows what antibiotics certain pathogens are sensitive to in the hospital. These antibiograms will also demonstrate what antibiotics specific pathogens are likely to be resistant to.
You can find the antibiogram page (adults) for Orlando Health here.
What is the role of Pharmacists and Infectious Disease physicians?
Pharmacists and Infectious disease doctors will play a vital role in fighting antibiotic resistance. Both are well-equipped to keep healthcare providers up to date on what pathogens have developed resistance to specific antibiotics. They are also helpful resources to ensure adherence to antibiotic stewardship and educate members of the healthcare team about the importance of this practice.
What I can do to help?
If you are a healthcare provider, you can research antibiotic stewardship further using the links below and enact your own policy in your practice.
All other members of the healthcare team can practice good antibiotic stewardship by exercising caution whenever deciding whether requesting antibiotics for an illness is absolutely indicated. As a patient, you can do your part to prevent antibiotic resistance by ensuring that you completely finish your prescription of antibiotics and never dispose of antibiotics in an unsafe manner.