Change Your World Week Fall 2021 (Archived)

The link between increased antibiotic use and increased uprise in superbugs has become public knowledge in and out of the healthcare industry. Where the blurred perception begins, however, is the misunderstanding of how exactly this pathogenic microorganism evolves into an emerging disease. Resistant infections can be classified as either Gram-positive or Gram-negative and through the years a plethora of mutated infections have developed in both of these categories. Some common Gram-Positive resistant strains include; Penicillin-Resistant Streptococcus pneumonia and Methicillin-Resistant Staphylococcus aureus. Some common Gram-Negative bacteria strains include; Ureidopicillins (piperacillin) and Third-or-fourth generation cephalosporins.

Relevance to properly diagnosing the specific bacteria type is of utmost importance, misdiagnosing this can have grave consequences. Some characteristics of a gram-negative cell are that a gram-negative cell wall is much weaker than that of a gram-positive cell wall. The gram-negative cell contains two membranes, while the gram-positive contains one that is made of thick peptidoglycan. Using the wrong antibiotic can make it difficult for that antibiotic to reach the cell, and also cause the bacteria to become more resistant.  

There are some opposing viewpoints of what the main contributor is to the development of superbugs. Some researchers believe that more attention should be given to our livestock because they house a specific type of MRSA, known as livestock-associated sequence type 398. Another point of interest in the development of superbugs has to do with the excessive use of antimicrobials to control microorganisms in crops and maintaining sanitary environments in slaughterhouses. All around, research has concluded that the evolution of bacteria mutations has come about due to man-made chemical substances.   

Most of these specific MRSA strains are more relevant in countries like Thailand, Korea, and Brazil. In the medical journal, "Prevalence and Characteristics of Antimicrobial-Resistant Staphylococcus and Methicillin- Resistant Staphylococcus Aureus from Retail Meat in Korea", supports my findings. "Transmission mission of MRSA from food animals to humans was first realized in case of swine, since pig farmers and family members were found to be infected with MRSA sequence type 398. Since then studies worldwide have documented the presence of MRSA  in various food-producing animals and people in frequent contact with these animals. In Korea, MRSA has been reported in nonclinical sources, including pigs, milk, and dogs, as well as clinical isolates." (Kim, Y. H., Kim, H.S., Kim, S., Kim, M., & Kwak, H. S., 2020).

AMR (Antimicrobial Resistance) is another point of interest in the Agricultural world. This type of resistance is brought on by excessive use of antimicrobial's for sterilization of slaughter houses, as well as to reduce the amount of microbes in crops. The problem rests with the amount of antimicrobial potency and selective toxicity. Authors in the research journal, "Selection and dissemination of Antimicrobial Resistance in Agri-Food Production", explain this phenomenon, "Although widespread AMR has been mostly attributed to the selected pressure generated by overuse and misuse of antimicrobials, concerns have been raised based on recent growing evidences regarding co-selection for AMR among bacteria exposed to non-antibiotic compounds used in agri-food industry, such as biocides used as disinfectants, antiseptics and preservatives, heavy metals existing in nature and used in agricultural production. The use of antimicrobials, heavy metals and biocides in food and agriculture has direct as well as indirect effects on the development of AMR in bacteria which can enter the food chain." (Cheng, G., Ning, J., Ahmed, S., Huang, J., Ullah, R., An, B., Hao, H., Dai, M., Haung, L., Wang, X., & Yuan, Z., 2019)

"Resistance of Gram-Positive Bacteria to Current Antibacterial Agents and Overcoming Approaches", the Authors cover current research strategies in identifying gram-positive bacteria and the bacteria's characteristics. "Gram-Positive bacteria can be identified using crystal violet dye, which interacts with the bacteria to yield blue color under a microscope examination; this refers to the ability of the thick peptidoglycan layer to retain the dye. The cell wall of Gram-positive bacteria differs from the gram-negative in which it lacks the outer membrane and has a thick layer of PG that surrounds the plasma membrane to protect the gram-positive bacteria from the harsh environment where they live." ( Karaman, R., Jubeh, B., & Breijyeh, Z., 2020)

In the Medical Journal, "Methicillin-Resistant Staphylococcus Aureus in Hospitals: Latest Trends and Treatments Based on Bacteriophages", Pilar Garcia discusses specific DNA mutations present in S. Aureus. "One of the most problematic bacterial pathogens at present is Staphylococcus Aureus, the causative agent in the skin and soft tissue infections (SSTIs), Osteomyelitis, Endocarditis, and Pneumonia, among other serious infections, all of which can ultimately lead to bacteremia and sepsis. Strains of this bacterium have been gradually acquiring antimicrobial resistance determinants throughout the antibiotic era. Methicillin resistance in S. Aureus is due to the presence of the mecA( or mecC) gene. Which encodes the penicillin-binding protein PBP2A, which has a low affinity for semisynthetic penicillins. These methicillin resistance determinants are part of the mobile genetic termed the Staphylococcal Cassette Chromosome mec (SCCmec), which is inserted into the S. Aureus chromosome." (Alverez, A., Fernandez, L., Gutierrez, D., Iglesias B., Rodriguez, A., & Garcia, P., 2019)

Something that all of us can do is be self advocating when it comes to our healthcare. Insisting to medical professionals to culture infections, rather than go along with healthcare plans that carry no scientific substance of being necessary will make a great difference for us as individuals but also reduce the overall cases of super-bug development. Another thing that everyone can do to help is to finish all prescribed antibiotics and never miss doses! By finishing the antibiotic prescription it is ensuring that pathogenic bacteria does not become resistant, and have the opportunity to overpopulate. Healthcare professionals can make a difference in MRSA development by practicing standard precautions, as well as proper isolation precautions. As healthcare professionals, we should prioritize quality of care provided to our patients, part of this is being thorough from the very start of each case and preforming the necessary cultures to properly identify bacteria. The only way to properly treat infections is to properly identify the type of bacteria, in order to prescribe accurate medications. 

 To encourage these cultures to be completed, my plan of action is to write to the State of Michigan Health Department  to drive a mandate for all bacterial infections to undergo laboratory examination before antibiotics can be prescribed. To support my purpose, I ask that you (the reader) please sign my petition that I have attached.

https://chng.it/TpFMkfCGSz

Alvarez, A., Fernandez, L., Igesias, B., Rodriguez, A., & Garcia, P. (2019). Methicillin-Resistant Staphylococcus aureus in Hospitals: Latest Trends and Treatments Based on Bacteriophages. Journal of clinical microbiology, 57(12), e01006-19. https://doi.org/10.1128/JCM.01006-19

Cheng, G., Ning, J., Ahmed, S., Huang, J., Ullah, R., An, B., Hao, H., Dai, M., Haung, L., Wang, X., & Yuan, Z. (2019). Selection and dissemination of antimicrobial resistance in Agri-Food production. Antimicrobial resistance and infection control, 8, 158. https://doi.org/10.1186/s13756-019-0623-2

Karman, R., Jubeh, B., & Breijyeh, Z. (2020). Resistance of Gram-Positive Bacteria to Current Antibacterial Agents and Overcoming Approuches. Molecules (Basal, Switzerland), 25 (12), 2888. https://doi.org/ 10.3390/molecules25122888

Kim, Y. H., Kim, S., Kim, M., & Kwak, H.S.(2020). Prevalence and Characteristics of Antimicrobial-Resistant Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus from Retail Meat in Korea. Food science of animal resources, 40(5), 758-771. https://doi.org/10.5851/kosfa.2020.e50