Cedarville University professor helps fight superbugs

They don’t have brains, but bacteria are smart.

They’re smart enough to hang out in hospitals and other care facilities where people are sickest and may have weakened immune systems.

They’ve used that edge to learn how to develop resistance to the antibiotics we use to defend ourselves against them.

And they’ve done so well enough that they landed a spot on the White House agenda earlier this year when President Barack Obama hosted a summit on what can be done to fight what amounts to a biological insurgency.

Twenty-nine-year-old Zachary Jenkins is one of the people trying to help our species regain a competitive edge against these so-called superbugs.

A doctor of pharmacy and assistant professor at Cedarville University School of Pharmacy, Jenkins also works as an infectious disease pharmacist on a Premier Health Partners team that’s on the front lines devising strategies to fight drug-resistant bacteria.

Premier is not unique in its efforts to improve its “antimicrobial stewardship” — the innocuous sounding name of what the U.S. Centers for Disease Control and Prevention call “perhaps the single most important action” we can take in the battle.

The goal of antimicrobial stewardship is to use antibiotics more strategically and wisely; to do so in a way that limits the opportunity for microbes to develop resistance; and to make sure we’re using antibiotics only when they’re effective and needed.

Most have heard of MRSA, one of the “superbugs” known to hang around hospitals and long-term care facilities.

Well, for the moment, it has taken a back seat to the infection C. difficile — more widely known by its gansta rap sound nickname, C. diff.

Earlier this year, C. diff grabbed headlines when the Centers for Disease Control announced that it plays a part in killing about 29,000 people a year in the U.S. — more than twice the estimate given just two years ago.

Most of its victims are ill, older than 60 and often contract it in hospitals and other long-term care facilities.

People on dialysis, those who have had joint replacement surgery and those who have received organ transplants are among those at highest risk.

The bug’s biography also provides a glimpse at how tricky bacteria can be.

C. diff is actually inside almost all of us but, in most circumstances, is not dangerous.

Why?

It’s typically kept in check by other bacteria inside our intestines.

C. diff can become a danger when its competitors disappear — something that happens when particularly vulnerable patients are treated with antibiotics that kill C. diff’s competitors, allowing it to run wild.

Our use of antibiotics in these patients actually provides the opportunity for this “opportunistic” infection to flourish.

Because C. diff is just one of many bugs identified as an “urgent threat” by the Centers for Disease Control, its example is what Jenkins considers a “humbling reminder” that we should always weigh the risks and benefits of an antibiotic before we use it.

The good news about C. diff is that it’s not currently known to be antibiotic resistant. The bad news is that if it becomes resistant, it could be all the more lethal.

So Jenkins and others are trying to ferret patterns like the one that makes C. diff a danger — instances in which use of antibiotics allow bugs to flourish and gain an edge, whatever that is.

Jenkins says its big-time detective work in which “we have to look for patterns.”

The patterns can vary depending on the infection being treated, the stage of a patient’s disease and the degree to which a person’s immune system is compromised.

Nor are the disease and treatment the only variables. Another is how diligent we are in sterilization practices and procedures.

Even a missed swipe or a diluted cleaner might allow bacteria to make a home on an otherwise sterile piece of diagnostic equipment — a home in which the bacterial can live until another patient comes along to infect.

The dangers associated with antibiotic resistance may also present a challenge to one of the standard practices of medical care known as “empiric medicine.”

To illustrate, Jenkins used pneumonia, which can be caused by a variety of bacteria. Unfortunately, tests for telling one from another aren’t always available or can be very expensive.

Because they don’t want to delay treatment, for fear the patient’s condition will worsen, doctors decide, given the evidence they have, which bug they think is causing the pneumonia.

They then prescribe the antibiotic most effective against that bug and monitor the patient’s progress.

The problem is that when the diagnosis is wrong, the surviving bacteria get another shot at learning how to become resistant to that drug.

Jenkins said fighting the battle against resistant bacteria means “making sure we’re using (antibiotics) in the right situations, in the right patient at the right dose at the right time.”

That means data crunching and use of all the IT power we have.

There are other issues in the battle against drug-resistant bacteria.

One is the reality that antibiotics are not as profitable for drug companies to develop as other pharmaceuticals, which means there aren’t a lot of new ones in the pipeline.

Another is the role played by the use of antibiotics in the animals we eat.

But while others are at work on those things, there’s something you and I can do — a part we can play to help our species in this ongoing battle.

Every time we take an antibiotic when it’s not needed, we give bacteria one more chance to figure out how the antibiotic works and how to resist it.

Every time we fail to take all the antibiotics properly prescribed because we’re starting to feel better, we give the bacteria we’re fighting a chance to survive and another chance to figure out ways to outsmart another antibiotic.

So when we go to the office with an illness of some kind, before asking a doctor to prescribe an antibiotic, we should ask another question: Will an antibiotic actually help?

Because if the answer is no, if we still insist on having something to make us feel better — and if we convince our doctors prescribe an antibiotic that really won’t do us any good — we all lose and the bacteria win.

To be good antimicrobial stewards, we have to adapt and learn to be smarter than the bacteria using the best tools we have.

We have to use our brains.

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