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Ask a Prof: How bad is this “superbug” from Nevada?

Last week, a “superbug” infected a woman in Reno, Nevada. This superbug was called such because of its resistance to all known antibiotics, posing a serious threat to modern medicine.

We sat down with Dr. Stephanie Smith at the University of Alberta to find out more about this class of disease. Dr. Smith is Assistant Professor of Infectious Diseases and Director of the Adult Infectious Diseases Training Program. She manages students as they continue their medical studies in graduate and post-graduate studies in adult infectious diseases. She also specializes in HIV Health Care in collaboration with HIV Edmonton.

The Gateway: How bad is this superbug from Nevada?

Dr. Stephanie Smith: It’s pretty scary. We have very few antibiotic options for the type of resistance these bacteria have. A broad range of bacteria can carry this resistance mechanism, and that mechanism can jump from one species to another. When we see people having infections with this, and we have maybe one antibiotic left at our disposal that tends to be very toxic, it’s not a great option.

What is your opinion on this?

For the general public, it’s not a serious threat. For the average healthy person, it’s probably not much of a threat right now. The threat is really for patients that are hospitalized. The vast majority of the patients that have gotten this superbug both in the United States and in Canada are mostly people that are in nursing homes or are hospitalized for other reasons.

Why is this especially prevalent in hospitals?

It’s a combination of a bunch of things. Firstly, you have a lot of patients that have problems with their immune systems. Also, they tend to be on a variety of medications, often including a lot of antibiotics. That wipes out good gut flora and allows patients to become colonized with some of these more resistant organisms. Then, there’s the issue of people being in tight quarters, so it’s easily transmitted within the hospital. I do infection control for the hospital — I’d like to think that our hospitals are clean, but there is a greater risk in a hospital of transmission of bacteria.

Are we at risk of these diseases here in Canada, in hospitals or otherwise?

Yes, would be the short answer. We do surveillance for these resistant bacteria, meaning we test patients who have travelled from or received hospitalized care anywhere outside of Canada to see if they have these resistant bacteria. We isolate them if they do. We do see patients with resistant bacteria, but compared to even the United States, the numbers are still pretty small. Overall, we have 58 sentient hospitals across the country that put their surveillance data together. Over the last seven years, there have been about 700 people that have been identified as being colonized with these bacteria, which is not a huge number in the whole scheme of things. So, yes, we do see it in our hospitals, but we see it fairly infrequently, so we still take it fairly seriously.

What do you think the Alberta Health Minister will do in response to increased awareness of these sorts of bacteria?

I think we have pretty good systems in place right now, but I think that in the long-term, beyond the Health Minister and Canada, we need to develop new antibiotics. It’s been over 30 years since we’ve had an antibiotic in a whole new class developed. There are new antibiotics that have been developed, but they’re all in the same classes we already have, so they’re still in the same penicillin family, for example. A whole novel class of antibiotic has not been discovered since 1987, and that was not for this kind of bacteria. We have a problem in terms of drug development.

If we are in a high-risk situation, such as in a hospital, what can we do to protect ourselves from this disease?

You need to make sure all the healthcare workers that are going to touch you have cleaned their hands. No healthcare worker should be upset if a patient asks them to clean their hands, because no one should touch you without clean hands. Also, making sure that patient care items, like if you’re getting your blood pressure taken, all that equipment should be cleaned as well. You have the right to ask if it’s been cleaned. Another thing that is related more to the hospital is making sure antibiotics are used judiciously. Only use them if you have a documented bacterial infection, not a viral infection, since we know overuse of antibiotics can put pressure on bacteria to develop more resistance.

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