By Sharadha Kalyanam
WASHINGTON (October 2, 2015)—Nursing homes in the United States are battling a surge in the number of infections caused by a deadly superbug, prompting the Centers for Disease Control and Prevention (CDC) to urge stepped-up preventive measures.
The superbug is called C.Difficile, one of the leading causes of healthcare-associated infections in the country and known to be resistant to antibiotics. The bacteria can cause severe diarrhea, colitis and inflammation of the colon.
The CDC wants to encourage doctors and caregivers in nursing homes to pay special attention to the prescription and use of antibiotics, among other measures. The agency has issued guidelines to tighten existing measures to fight superbug infections.
An estimated 4.1 million people live either temporarily or permanently in nursing homes.
“One way to keep older Americans safe from these superbugs is to make sure antibiotics are used appropriately all the time and everywhere, particularly in nursing homes,” CDC Director Tom Frieden said in a statement.
Nearly 70 percent of residents in nursing homes receive one or more courses of antibiotics during a year and up to 75 percent of these antibiotics are given incorrectly, according to the CDC.
Another superbug called Methicillin-resistant Staphylococcus Aureus (MRSA) is known to cause pneumonia and life-threatening bloodstream infections and continues to be a threat, health experts said.
“MRSA has been a consistent issue for long-term care facilities. It is a costly and important issue that increases length of stay and hospital costs,” said Dr. Jason Farley, associate professor at Johns Hopkins University School of Nursing’s department of community public health in Baltimore.
The rising number of C.Difficile infections is worrying the CDC.
This is because the incidence and severity of the infection caused by the bacteria has increased exponentially over the last decade, said Dr. Lona Mody, professor of internal medicine at the University of Michigan’s division of geriatric and palliative care medicine in Ann Arbor.
Mody’s recent study, in the Journal of the American Medical Association (JAMA) Internal Medicine, found that simple measures could reduce superbug infections in nursing homes.
C.Difficile can contaminate bed rails, furniture, toilets, bedpans, weighing scales, and therapy and medical equipment. There are very high chances of cross-transmission because the bacteria are present in so many places, Mody said.
“C.Difficile spores are notoriously difficult to eradicate from these surfaces; commonly-used detergent-based cleaners are not effective although a 10-percent bleach solution is effective,” Mody said.
Infections can also spread through urinary catheters, feeding tubes, ulcers, wounds, urinary incontinence and previous hospital stays, Mody said.
“More than 50 percent of nursing home residents with indwelling devices (medical devices fixed in a person’s body) are colonized with a superbug,” she said.
The problem starts when an antibiotic is prescribed based on a patient’s wishes and not based on the knowledge of his or her actual medical needs, Farley said. For example, a parent asks for an antibiotic to cure a child’s fever when most low-grade fevers in kids during school season are caused by viruses, he said. Antibiotics have no effect on viruses.
“Viral syndromes, ear infections, sinus infections and things like that need not have antibiotics,” said Dr. Lisa Maragakis, senior director of healthcare epidemiology and infection control for The Johns Hopkins Health System in Baltimore. “Prescribers should not give it for longer courses than are needed, and they shouldn’t choose a very broad-spectrum antibiotic when a much narrower one would work.”
Infections don’t necessarily stop in the nursing homes: they could be transmitted to households or the community once a patient is discharged, medical experts warn.
“You know the very young and the very old are part of those populations that are most impacted - also, persons whose immune system isn't the strongest,” Farley noted.
Common antibiotics like ciprofloxacin and levofloxacin frequently prescribed in outpatient procedures and for respiratory and urinary tract infections are cause for concern, Maragakis said.
“It's critical that scientists, and the National Institutes of Health (NIH) and other pharmaceutical agencies have the appropriate resources to continue drug development. If we don't prevent (antibiotic resistance), then we need appropriate treatment options,” Farley said.