Hi, and welcome to our video on superbugs.
Okay. This is a huge problem
in antibiotic treatments.
So we'll talk about these superbugs as we
discuss all the other antibiotic videos,
but I want to take this one video
just to really focus on the
problem of super bugs.
Now, what is a super bug? Because that
might sound like a hero, but actually,
it's a villain.
These are bacteria that we used to be
able to control with antibiotics,
but now they're no longer sensitive to
these antibiotics, and they're very,
very difficult to treat.
So these can make huge problems for
your patient, and for you.
So, let's take an example.
Enterococcus used to be
sensitive to vancomycin.
Now, not any longer, It is
resistant to vancomycin.
So we call this superbug, instead
of just enterococcus,
now we call it vancomycin-resistant
or VRE because that is a mouthful to say.
So I want to talk to you about
some superbugs today,
so you can be aware of what they are,
how we treat them, and then we're
going to talk about how not
to develop more super bugs.
Now, we want to know who's
at risk for these crazy bugs.
Usually, it's hospitalized patients.
Now, think about that.
Take a minute and think before
you read your notes,
why would hospitalized patients
be more at risk
to develop these superbugs?
Okay, now, let's come back and talk about that.
Hospitalized patients have lots
of multiple problems, right?
They wouldn't be in the hospital unless
they weren't already not feeling great.
So, usually their immune systems are under
attack for one reason or another.
So they've got higher odds of contracting
a superbug because of that.
So they're already in a something of
an immunocompromised state.
It's the place where we give a lot of these
drugs that can cause superbugs,
and they've probably dealt with a surgery
or they have IVs or catheters.
And what that means is, we've
broken their host defenses.
If you have a catheter, that's like
a escalator right up into your
UTI tract for bugs to go.
If you have an IV, we've broken the skin.
That's like a, "Hey, guys. Come on in,"
kind of moment, if you have an IV.
Also surgery, you're doing the same thing.
When you cut through that
skin and that tissue,
you're really at an increased
risk for infection.
So these are the types of people that
are likely to be on antibiotics.
These are the people that are likely
to have been some type of
compromise to their body,
and they have a weakened immune systems.
So, the reason that hospitalized
patients are at higher odds
is because they might be immunocompromised
or have weakened immune systems,
they're having antibiotics with treatment,
and we've done something to them
while they're in the hospital
that put them at risk.
We've started an IV, we've put in an IV
catheter, or we've done surgery.
So, already, I want you to
start thinking about
everyone you interact with in the hospital,
not as being super contagious,
but as being someone who
is at definite risk.
That's why we've worked really
hard in the recent years
to minimize the use of catheters,
like for urinary drainage.
We've tried to minimize that use because
we know how risky and dangerous it is.
Now, it's not the most convenient
for the patient,
and it does put us at some extra concern
helping patients in and out of bed,
help them use the restroom, but in the
long run, it's much better for everyone.
Okay, let's talk about C. difficile infection.
Hey, it almost sounds sophisticated till
you know what we're dealing with.
It is the most common infectious
cause of nosocomial diarrhea.
And I wish -- you know like on cooking
shows, they always say, "Mm,
I wish you could smell this food."
Well, I wish I could just give you some
smell-o-vision for this CDI, because
it is phenomenal. It will get stuck
in your nasal passages,
and you'll wish you could get
that smell to go away.
The diarrhea is also problematic
to deal with, but this is all
caused by a gram-positive anaerobic bacillus.
Now, you see that in the picture.
We know that it's gram-positive
because it stains purple,
and you can see that we've got
a purple picture for you.
And it is a bacillus because that's
the shape of the bug.
So when you're looking at your
culture and sensitivity reports,
you'll see those words on your report
and you'll know what that means.
Remember, gram-positive is supposed
to be easier to treat,
but once it's become a superbug
or a resistant bug,
it's no longer easier to treat.
This becomes extremely difficult to treat.
Now, some of this stuff
is going to be very frightening for
you as we talk about it because
one of our normal host defenses is gastric
acid should take care of bugs.
Nope, not C. diff.
It can survive gastric acid and then
start to infect the bowel,
and that's why you end up
with this horrible diarrhea.
Because these bugs, they can secrete
toxins that causes diarrhea
and this Pseudomembranous colitis.
That's where you get the horrible
smell that comes with it.
So, normally, we used to be able to
treat these bugs with antibiotic
or maybe they'd be knocked
out by our gastric acid,
but not the superbugs.
They can survive the stomach,
make it into the gut,
and then they start wreaking havoc
by secreting these toxins that
caused that horrible diarrhea,
and that Pseudomembranous colitis.
So this is the part that can
keep me up at night.
In fact, when I had to be in the hospital,
I kept looking at my bedrails thinking,
"Oh, oh, oh, what is growing on
here? What's on my table?"
I was probably the only
person in the hospital
that was wiping down her own surfaces
because I just would overthink
all the things.
I had too much time to worry
when I was in the hospital.
These spores, these C. diff spores can stay
on hard surfaces for weeks, okay?
That freaked me out when I were
thinking about that in the hospital.
It should be a good reminder
for you how important it is
for us to take extra precautions with
all our patients with contact.
So, spores can stay on hard
surfaces. That could be
a bed rail, that could be the bedside
table. That could be the floor.
And these spores are present in stool.
So because these patients deal
with this horrible diarrhea,
it's very easy for them to spread stool
in places that you wouldn't
So when you're caring for
a patient with C. diff,
you want to be extra careful
in how you clean
both the patient -- make sure
and their skin is well and intact--
and you also want to be careful
that you're very careful
in the environment to keep
things super clean.
I had a friend whose mother developed
C. diff when she was at home,
and they had to totally turn
their house upside down.
They only had her use 1 bathroom
and 1 area just to try to limit that,
and they were successful. No one
in the house caught C. diff,
but they had to be very strict with
how they handled that.
Now, I want to talk to you
about the symptoms,
the causes, and the treatment. I've told
you enough about the scary stuff,
but let's kind of break this down
into those 3 categories.
You kind of keep this in mind
when you're thinking about
Clostridium difficile infection.
Okay, so the symptoms they can be --
we call them relatively mild,
but if you're having diarrhea
10 to 20 times a day,
I would think that's going
to be life altering.
But it can be GI distress, that really foul
smelling diarrhea we've talked about,
but it can also lead to really
more severe ramifications.
Because this could lead -- C. diff
infection could actually lead
to a sepsis that leads to death.
So this actually can be life threatening.
That does not mean that everyone
who gets C. diff
is going to develop sepsis,
but it is a risk factor, so keep that in
mind. You always want to take --
you always want to remember
this is a serious issue,
and we have to do everything we can
to try to treat it quickly and efficiently.
So the symptoms can be GI distress,
pretty nasty diarrhea,
all the way to the severe form that
leads to sepsis and death.
Well, what causes this? Like, who's most likely?
We talked, in the beginning, that
usually, it's hospitalized patients.
But usually, it's patients that have
had a bacterial infection
and we treated it with a broad-
that kind of messed with their
normal gut flora.
Remember, that's how resistance happens.
A broad-spectrum antibiotic --Look, they've
got a great picture for you there.
See how they have the different
shapes of bacteria?
That's to remind you and
reinforce that concept
of broad-spectrum antibiotics. They go
after lots of different kinds of bacteria.
Remember, you have good bacteria in your gut,
and when we give you a broad
we knock out those good bacteria.
When we knock out those good bacteria, too,
in addition to try and deal
with an infection,
now the bad bugs, the superbugs
have more resources available to them
and sometimes, they flourish.
So, that's why you think of a patient who's
most likely had a bacterial infection
that we treated with a broad-
Even if that was the most
it puts them at risk for developing
something like C. diff.
So, we've got some examples listed
for you there at the bottom.
Those are some of the broad-
that we really watch a patient
closely for after for C diff.
So, clindamycin, cephalosporins,
and the fluoroquinolones are
ones that we know,
patients might be at an increased
risk to develop C. diff.
Okay, so we've talked about the symptoms,
you know, from mild GI distress
to severe diarrhea to sepsis.
We've talked about the causes.
They've likely been treated for
a recent bacterial infection
with a broad-spectrum antibiotic.
And I've given you some examples of some
of those antibiotics to keep in mind.
So, what do we do to treat this?
Well, once C. diff has been diagnosed --
and you know how we do that, right?
We'll have to actually take a sample
of the diarrhea stool,
send it down to lab, they will culture it.
And obviously, they'll do a culture and
a sensitivity on that stool sample.
So, once we know that we have C. diff,
we'll stop the antibiotic. If they're
still on that antibiotic,
we'll stop the antibiotic that
caused that overgrowth
and start a 2 different
choices of antibiotics.
So, remember, though, this can develop
even after antibiotic usage has stopped.
So, if the patient develops this C. diff,
we want to make sure if they're still
on that antibiotic that we started.
And I've got 2 options there
for you to use, or to consider
for treating C. diff.
So make sure you underline
both of those medications
because that's really important
for you to remember.
Now, we'll decide between those 2 medications
-- and you see them on your screen --
based on the severity of the
symptoms and lab work.
So, it's not just a, "Oh, we'll
always use this drug,"
or, "We'll always use that drug."
The issue is we got to look at
that culture and sensitivity
and see how severe the symptoms are,
and then we'll make the best choice
for that particular patient.