Pan-drug resistant bacteria on the rise in hospital ICUs

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Pan-drug resistant bacteria on the rise in hospital ICUs

Antibiotic resistance is a mounting concern in hospital settings and prolongs infections

New Delhi, 15 November 2017: Recent statistics indicate that about 7-8% of patients admitted in the intensive care units (ICU) are infected with pan-drug resistant bacteria.[1] It becomes very difficult to destroy these bacteria with existing antibiotics. As a result, infections persist for a longer duration and the treatment is also harder and more expensive. Infections that are not sensitive to any antibiotics require to be treated with a cocktail of antibiotics belonging to different categories.

Antibiotic resistance falls under three categories: Multidrug resistance (MDR), extensively-drug resistance (XDR) and pan-drug resistance (PDR). Of these, pan resistance is the toughest to treat. This is followed by XDR infections, which do not show a response to at least one drug in all but two or less antimicrobial categories. MDR infections do not respond to at least one drug in three or more antimicrobial drug categories. PDR bacteria do not respond to any drug in all antimicrobial categories. The incidence of infections falling under the pan resistance category is seeing a rise.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “People reach a tertiary care center only after they have consumed antibiotics prescribed by numerous other hospitals. There are very few new antibiotics in the pipeline. Last year, a new antibiotic called ‘teixobactin’ was discovered. It is the first antibiotic to be discovered in three decades and is still in at an early stage of development. Options are running out now with a lot of hard work required to protect the efficacy of existing antibiotics. There is a need to ensure that they are used only when necessary. Every hospital should also have an antibiotic policy for all its ICUs depending on the resistance pattern determined by the microbiology department.”

The WHO has recognized antibiotic resistance as a significant public health problem in its first global report released in 2014. Further, it indicates that no age group is exempt from antibiotic resistance.

Adding further, Dr Aggarwal, said, “Patients often demand antibiotics even when the doctor thinks it is unnecessary. Antibiotic consent should be a part of the informed consent process so that the patient is aware of the benefits and risks of antibiotics. If you have prescribed antibiotics, put the name of the antibiotic in a box underline it so that patient can identify the antibiotic in the prescription. Write the total number of antibiotic tablets capsules to be taken for the prescribed duration in the prescription and not just the dose administration schedule.”

Some tips to prevent antibiotic resistance include the following.

  • Take antibiotics exactly as prescribed and avoid skipping doses.
  • Complete the prescribed course of treatment, even when you start feeling better.
  • Do not share or use leftover antibiotics. Antibiotics are meant to treat specific types of infections. Taking the wrong medicine may delay treatment and allow bacteria to multiply.
  • Discard any leftover medication once the prescribed course of treatment is completed and do not reuse them if you fall sick again.
  • Do not ask for antibiotics if the doctor says you do not need them. Antibiotics have side effects.
  • Prevent infections by practicing good hand hygiene and getting recommended vaccines.

AHA re-defines high BP in its new guidelines:

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New guidelines from the American Heart Association AHA and the American College of Cardiology ACC for detection prevention management and treatment of high blood pressure have redefined high blood pressure for first time in 14 years. The guidelines were presented November 13 2017 at AHA s 2017 Scientific Sessions conference in Anaheim In a change from the older definition of 140 90 and higher high BP is now defined as systolic BP 130 mm Hg and higher or diastolic BP 80 and higher. By lowering the definition of high BP the guidelines recommend earlier intervention to prevent further increases in blood pressure and the complications of hypertension. The importance of using proper technique to measure BP has been emphasized. Blood pressure levels should be based on an average of two to three readings on at least two different occasions. The new guidelines have eliminated the category of prehypertension which was used for blood pressures with a top number systolic between 120 139 mm Hg or a bottom number diastolic between 80 89 mm Hg. People with those readings now will be categorized as having either Elevated 120 129 and less than 80 or Stage I hypertension 130 139 or 80 89 . Previous guidelines classified 140 90 mm Hg as Stage 1 hypertension. This level is classified as Stage 2 hypertension under the new guidelines. High blood pressure should be treated earlier with lifestyle changes and in some patients with medication at 130 80 mm Hg rather than 140 90. Medication for Stage I hypertension should be prescribed if a patient has already had a cardiovascular event such as a heart attack or stroke or is at high risk of heart attack or stroke based on age the presence of diabetes mellitus chronic kidney disease or calculation of atherosclerotic risk. Blood pressure categories in the new guideline are Normal Less than 120 80 mm Hg Elevated Top number systolic between 120 129 and bottom number diastolic less than 80 Stage 1 Systolic between 130 139 or diastolic between 80 89 Stage 2 Systolic at least 140 or diastolic at least 90 mm Hg Hypertensive crisis Top number over 180 and or bottom number over 120 with patients needing prompt changes in medication if there are no other indications of problems or immediate hospitalization if there are signs of organ damage. Source AHA News Release November 13 2017