Wednesday, October 7 , 2015, 6:28 am | Fair 56º

As Superbug Hits California, South Coast Specialists Warn Against Overuse of Antibiotics

Local health-care officials say the emergence of a multidrug-resistant pathogen is an opportunity to reassess the treatment of infections

Leslie Stanfield, director of Infection Prevention and Control at Santa Barbara Cottage Hospital, says that when dealing with multidrug-resistant organisms, surveillance is key.
Leslie Stanfield, director of Infection Prevention and Control at Santa Barbara Cottage Hospital, says that when dealing with multidrug-resistant organisms, surveillance is key.  (Lara Cooper / Noozhawk photo)

By Lara Cooper, Noozhawk Staff Writer | @laraanncooper |

Researchers announced last week that they found unexpectedly high rates of a multidrug-resistant pathogen in patients in long-term acute care hospitals in Los Angeles County. Bacteria with the same proteins as the pathogen have been found on the South Coast, and infectious disease specialists are cautioning the public about overuse of antibiotics.

The pathogen found in Los Angeles — carbapenem-resistant Klebsiella pneumoniae, or CRKP — was previously thought to be contained to the East Coast.

“CRKP is resistant to nearly all antibiotic options and has been associated with higher mortality, longer hospital stays and increased health-care costs,” according to a news release issued by the Society of Healthcare Epidemiology of America

Dr. Dawn Terashita, an epidemiologist with the Los Angeles County Department of Public Health, and her team discovered 350 cases across the county in the course of six months.

The L.A. study didn’t go as far as to say how the bacteria got there, whether by improper care or other means. But “these patients tend to be elderly, they are commonly on ventilators and they often stay at the facility for an extended period of time,” Dr. Terashita said in a statement. “They tend to have many health problems and are often placed on antibiotics which may or may not be appropriate.”

All are factors that would contribute to a greater risk of health-care-acquired infections.

Locally, Dr. David Fisk with the Sansum Clinic’s Infectious Disease Department and director of Infection Prevention and Control for Santa Barbara Cottage Hospital told Noozhawk they had isolated bacteria with the same proteins as CRKP bacteria, but they’ve seen them only in their laboratory — a common lab that both Cottage and Sansum share, as well as other doctors.

So he said he can’t localize the bacteria, other than saying it’s from the Central Coast.

The CRKP bacteria is part of a larger spectrum of bacteria called gram negative bacteria, and there are many different mechanisms by which they become resistant to antibiotics.

Fisk said he fully agrees that “these are big threats.” He said he’s seeing many proteins that have high levels of antibiotic resistance in Santa Barbara, and the lab has identified in a handful of their lab cultures, but that there hasn’t been any clinical illness from these strains.

“Sometimes the lab identifies them, but they’re not linked to a problem,” he said, adding that the bacteria isn’t something that requires treatment. “You can be colonized with the bacteria but not infected with it.”

Though it’s unknown how many patients in Southern California have died from infections of CRKP bacteria, they are are associated with high mortality rates.

“When you see those rates, you have to keep in mind that many of these infections occur in pre-existing illness,” Fisk said.

He said doctors will also see higher mortality rates early on in an epidemic. “Over time, we tend to find cases that aren’t lethal,” he said.

Fisk said people who have come in to the Sansum Clinic with common infections, such as urinary tract infections, sometimes need to have antibiotics administered intravenously, instead of orally. Those gram negative bacteria are becoming more resistant as a whole, he said.

In terms of prevention, he said patients should work with their physicians to see if antibiotics are really needed.

“Fifty percent of the time, they are over-prescribed or inappropriately prescribed,” he said. “We have to change how we use them.”

Dr. Takashi Wada, director of the Santa Barbara County Public Health Department, said there’s no mandatory reporting of CRKP cases to the county. he said staff are still researching the issue, but that he wasn’t aware of any outbreaks of CRKP within the county.

Medical facilities, such as Cottage Hospital, have programs to monitor the presence of bacteria and how antibiotics are used internally.

Leslie Stanfield, director of Infection Prevention and Control at Cottage Hospital, said that when dealing with multidrug-resistant organisms, surveillance is key.

Several hospital departments, including the pharmacy, work with Infection Prevention and Control. An antibiogram is sent out every year to Cottage physicians, which “allows the physician to pick the best possible antibiotic for the organism in this community,” she said.

The hospital also has an electronic system set up that alerts Infection Prevention and Control if a patient comes in with a positive culture to the multidrug-resistant organisms, “so we can get them into isolation immediately,” Stanfield said.

She said hand hygiene is important for the community as well as health-care workers.

Cottage Hospital specifically has seen some of the drug-resistant Klebsiella bacteria, but not the CRKP, she said. People who are hospitalized for a long period of time, who have invasive devices and who are critically ill are more prone to these types of organisms, she said.

“Right now, we have a lot of focus in the OR picking the correct antibiotics,” she said, adding that the staff is working to expand that oversight systemwide.

Noozhawk staff writer Lara Cooper can be reached at .(JavaScript must be enabled to view this email address). Follow Noozhawk on Twitter: @noozhawk or @NoozhawkNews.

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» on 04.06.11 @ 04:41 PM

You could run an article like this every two years for the last decade, and see
almost no change in how antibiotics are used locally, or around the world.

Antibiotic and germ remnants still make it through the sanitation/sewer process,
and into the oceans, where the seafood chain absorb them.

Too many agricultural industry groups still give antibiotics routinely to keep
poultry, beef, pork “healthy” enough to meet federal food-processing standards.

Too many doctors - including many who hang their hats at Cottage and Sansum - still prescribe unnecessary antibiotics either to get rid of patients, or to justify
needlessly high office-visit bills.

And in the Third World, unlicensed or semi-licensed shops dispense antibiotics
by the handful, as if they were candy, whether a condition is diagnosed, or just
imagined, and whether they’re useful or not. Very rarely are clear instructions
given about completing the entire prescription, or on safe-disposal.

So, while is is a good discussion, there’s a whole lot more that California’s
licensed medical communities should be doing to slow this problem down, a
lot more that agriculture should be doing, and a lot more that the sewer/
sanitation districts should be doing.

But mostly, they’re doing what they do best. Talking and writing, not acting.

» on 04.06.11 @ 06:53 PM

There is such a shortage of qualified medical practitioners in Mexico that people end up using folk remedies and self prescribe and probably buy antibiotics over the counter in Mexican border towns, where they are cheap and black market. Without MD oversight, they take them at the wrong time. Since there is no way to prevent people from coming over the border, given that both major parties are stonewalling, and there are literally thousands of people sneaking over the border every day, this is a problem we will just have to live with. The only alternatives would be draconian “Berlin Wall” measures, or massive humanitarian intervention in places like Tijuana. But you can’t build a system that will seal the border, so whatever bug,virus,bacteria goes around in Tijuana comes around in Santa Barbara. Achoo!

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