The Threat of Antibiotic Resistant Bacteria

“Antibiotic resistance is one of the biggest threats to global health, food security, and development today,” (1) is the lead statement from a fact sheet the World Health Organization (WHO) published on its web site in February 2018.   WHO went further and added:

• Antibiotic resistance can affect anyone, of any age, in any country.
• Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process.
• A growing number of infections – such as pneumonia, tuberculosis, gonorrhea, and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective.

• Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality.

 

Furthermore, in a 2013 pamphlet (2), the US Center for Disease Control (CDC) stated that infections from antibiotic resistant bacteria cause over two million illnesses and results in over twenty-three thousand deaths every year.   The threat from antibiotic resistant microbes is a worldwide threat with national implications.  The origins of this threat can be traced back over seventy years ago.

 

One of the earliest pioneers in antibiotic research was a French medical student, Ernest Duchesne (3), who is credited with discovering the antibacterial activity of a soil mold, Penicillium glaucum, in 1896.     Later, in 1928, Alexander Fleming, a Scottish physician working at St. Mary’s Hospital, rediscovered the antibacterial activity of penicillium with a different strain of penicillium, Penicillium notatum.  Fleming tasked his assistants to isolate and purify the substance secreted by this penicillium mold.  However, this task was far more challenging than initially anticipated.  Eleven years later, in 1939, a team from Oxford University developed the process for the first penicillium based antibiotic therapy.  However, not until 1943 was a collaborative American – British effort successful in commercializing the first penicillium based antibiotic therapy.  Penicillium treatment proved to be one of the most important medical breakthroughs of the twentieth century.   Penicillium made a dramatic improvement in medical treatment of infections.  Penicillium cured a broad range of bacterial infections from strep throat to venereal diseases and saved countless lives.

Not too long after penicillium treatment had become widespread, researchers found that antibiotic treatments were losing effectiveness in certain cases.  Further examination discovered that some bacteria had developed a resistance to antibiotics.  As aforementioned, this new phenomenon of antibiotic resistance is the result of natural evolution and ecology.  Ernest Duchesne had observed that molds and bacteria have an antagonistic relationship where either the mold or the bacteria survives.  Infections treated with antibiotics will kill the vast majority of bacteria that have infected a person.   However, there will be a small number of antibiotic resistant bacteria that survives an antibiotic treatment.  These resistant bacteria survive because these bacteria have a genetic disposition to resist antibiotic therapies.  An old cliché states, “only the strong survive.”  This cliché applies to resistant bacteria that have an advantage or strength over non-resistant bacteria resulting in the survival of resistant bacteria. As the population of antibiotic-susceptible bacteria are reduced, the population of antibiotic-resistant bacteria increases.   Lastly, bacteria can pass on this genetic resistant trait to other non-resistant bacteria through the process of conjugation and transformation. (3), (4), (12)

As the rise in resistant bacteria grew, healthcare professionals became concerned about the inappropriate (overuse) use of antibiotic therapies for nonbacterial infections like colds and on healthy livestock.  Healthy cattle, chickens and hogs are treated with antibiotics to ensure these animals remain healthy before they are harvested. These same healthcare professionals want to limit the use of antibiotic therapies to patients suffering from serious bacterial infections. (3), (4)

Shortly after the introduction of penicillin, pharmaceutical companies launched other new antibiotic therapies like tetracycline and erythromycin.  These new antibiotic therapies are in the same class as penicillin, as each are derived by molds like Penicillin.   As seen with Penicillin, bacteria developed resistance to these new antibiotics.  See the chart (5) below that clearly illustrates the relationship of the introduction of a new antibiotics and appearance of resistant bacterial strains.   As when Penicillin was the dominant antibiotic therapy, with the addition of subsequent antibiotic therapies, we now see rising populations of bacteria resistant to specific antibiotic therapies.  Many of these resistant bacterial strains have been given names or acronyms that combine the antibiotic therapy with the resistant bacterial strain.  For example, one of the most common antibiotic-resistant bacterial strains is called Methicillin Resistant Staphylococcus Aureus, and the acronym given to this strain of Staph is “MRSA.”  Another example is Vancomycin Resistant Enterococcus, a family of bacteria that has developed a resistance to Vancomycin, another penicillium-class antibiotic therapy introduced in 1960 and referred to as the antibiotic of last resort.  Vancomycin Resistant Enterococcus has been given the acronym of “VRE.”    The CDC (4) classifies both MRSA and VRE as serious health threats. Both MRSA and VRE strains are derived from some of the most widely distributed bacteria in nature: Staph and Enterococcus. (9)

https://www.wsj.com/articles/superbug-from-india-spread-far-and-fast-study-finds-11548633600?mod=trending_now_2

 

MRSA has existed for over 60 years.   In the past 60 years, health professionals have encountered a growing number of antibiotic-resistant bacterial strains that involve either more than one type of bacteria and/or multiple antibiotic resistant strains.   One example is ESBL-producing Enterobacteriaceae.   ESBL (4) is an acronym standing for  Extended-spectrum β-lactamase, an enzyme that imparts antibiotic resistance to a family of bacteria (Enterobacteria) that includes Escherichia coli and Klebsiella spp.   ESBL Enterobacteriaceae are resistant to a broad number of penicillin and cephalosporins therapies.    On an annual basis, the CDC estimates that ESBL Enterobacteriaceae are the cause of a minimum of 140,000 infections resulting in 1,700 deaths. (4)

As earlier indicated, antibiotic-resistant bacteria strains are widely found in the environment: airports, hotels, homes, restaurants, and healthcare facilities.  Of the various environments where these strains can be found, healthcare facilities like hospitals and nursing homes are the environments where they can have the largest negative impact and cause the most harm to people.   When a patient in a healthcare facility becomes infected with a disease that they did not have prior to entering the facility, those infections are referred to as “healthcare associated infections,” (HAI) (8) or nosocomial infections.  The HAI becomes more serious when the infection stems from an antibiotic-resistant bacterial strain. Healthcare professionals treating a patient infected with such a strain have fewer tools to counter the infection than when treating those patients infected with a non-resistant bacterial strain.    On average, antibiotic-resistant bacteria infections can add $40,000 (8) in costs per patient per infection.   In 2009, Medicare (7) ceased paying for HAI treatments and compelled the healthcare facility to bear the costs of treatment.  Major healthcare insurance companies followed Medicare’s lead and have ceased paying for treatment of HAIs.   Today, healthcare facilities in the US are required to bear the costs of treating HAIs.  Therefore, healthcare facilities across the country are taking aggressive steps to reduce the risks of infections within their facilities.  (7)

One of the steps that healthcare facilities have taken to reduce the risks of nosocomial infections — especially against antibiotic resistant nosocomial infections — is to take a comprehensive approach to cleaning and maintaining their facilities.  Removing soot and soil is a fundamental first step in cleaning, but to reduce the risk of infections healthcare facilities need to go further.  Creating a hygienic environment by reducing the population of pathogens throughout the facilities — especially in common areas where people congregate, highly touched surfaces, restrooms and dining areas — is a pivotal part of reducing the risk of infection.   Adding a disinfection step to the cleaning regime is part of this comprehensive approach to cleaning and achieving a hygienic environment. (10)

Quat-based disinfectant products already play a critical role in many US healthcare facilities’ cleaning regimes.  These products offer a good balance of microbial efficacy, cleaning and ease of use.  In addition, quat-based disinfectants can reduce the risk of nosocomial infections and the risk of infection from antibiotic resistant bacterial strains because quaternary ammonium compounds (QAC), like the Maquat 128 – NHQ product, are equally efficacious against both antibiotic-resistant and non-resistant bacterial strains. Unlike antibiotics, quaternary ammonium-based surface disinfectants are not selective in their mode of action.   The Maquat 128 -NHQ (EPA Reg. No 10324 -155) is one of Mason Chemical’s many EPA-registered disinfectant products that are well suited for use in healthcare facilities and in a variety of other institutions and businesses.  EPA requires test data for each listed pathogen on any disinfectant product label.  Tests have demonstrated that Maquat 128 -NHQ is equally efficacious against non-resistant bacterial strains like Staphylococcus aureus and Enterococcus faecalis, and resistant bacterial strains like MRSA and VRE. In addition, Maquat 128-NHQ has proven microbial efficacy against over 50 other bacterial pathogens as well as over a dozen viral pathogens. (See Maquat 128-NHQ, EPA Reg. No.10324-155) product label. (10),(13)

The seriousness of the threat from antibiotic resistant bacteria has caused the US EPA to create a list of disinfectants that are effective against MRSA and/or VRE. Maquat 128 – NHQ along with over a dozen other Mason Chemical disinfectant products are listed on EPA List H: EPA’s Registered Products Effective Against Methicillin Resistant Staphylococcus aureus (MRSA) and/or Vancomycin Resistant Enterococcus faecalis or faecium (VRE).  EPA has recognized the surface disinfectant can play an important role in reducing the risk of infection from antibiotic-resistant bacteria.  Although there are many more types of antibiotic-resistant microbes (including yeast), the EPA selected MRSA and VRE as indicators of the strength required to disinfect the surrounding environment by one of the listed products.  Listed below is an abridged version of EPA List H with the Mason Chemical products that meet EPA List H’s criteria. (6)

In summary, the threat from antibiotic-resistant microbes is serious enough to warrant aggressive campaigns by the UN, WHO, the CDC and the EPA.  We are all at risk from this threat of resistant microbes.  Facility mangers of public buildings, especially healthcare facilities, can reduce this threat by taking a comprehensive approach to cleaning that includes a disinfection step.  Creating a hygienic environment in our schools, offices and hospitals is one of several ways to counter the threat posed by resistant microbes.   Quat-based disinfectants like Maquat 128 – NHQ is one of the many products from Mason Chemical that helps create this hygienic environment and counter the threat posed by resistant microbes.

 

1. WHO Facts Sheet Antibiotic Resistance https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance

2. Antibiotic Resistance Threats in the United States, 2013 https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf
3. Discovery and Development of Penicillin https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html
4. The Rise of Antibiotic-Resistant Infections by Ricki Lewis https://pdfs.semanticscholar.org/1332/a1f21271ebfdc97543b16881f183f338afb7.pdf
5. Superbug From India Spread Far and Fast, Study Finds by Brianna Abbott https://www.wsj.com/articles/superbug-from-india-spread-far-and-fast-study-finds-11548633600?mod=trending_now_2
6. EPA List H: EPA’s Registered Products Effective Against Methicillin Resistant Staphylococcus Aureus (MRSA) and/or Vancomycin Resistant Enterococcus faecalis or faecium (VRE) https://www.epa.gov/sites/production/files/2018-01/documents/2018.10.01.listh_.pdf
7. Medicare Will Not Pay for Hospital Mistakes and Infections, New Rule by Catharine Paddock https://www.medicalnewstoday.com/articles/80074.php

8. Healthcare Associated Infections https://www.cdc.gov/hai/organisms/cre/cre-statehealth.html

9. Microbiology David Kingsbury, Ph.D. and Gerald Wagner, Ph.D. Harwal Publishing
10. Guidelines for Environmental Infection Control in Health-Care Facilities https://www.cdc.gov/infectioncontrol/guidelines/environmental/index.html
11. Modes of Action of Disinfectants. Maris Rev. sci. tech. Off. int. Epiz., 1995,14 (1), 47-55

 

Mason Chemical Product found on EPA List H

Disinfectant Products with MRSA or VRE Claims

 

	Bacterial Strain		PRODUCT NAME		REGISTRATION NUMBER
MRSA ONLY		MAQUAT 64 PD		10324-93
MRSA ONLY		MAQUAT 128PD		10324-105
MRSA & VRE		MAQUAT 705-M		10324-177
MRSA & VRE		MAQUAT 32-NHQ		10324-157
MRSA & VRE		MAQUAT 512NHQ		10324-156
MRSA & VRE		MAQUAT 128-NHQ		10324-155
MRSA & VRE		MAQUAT 64-NHQ		10324-154
MRSA & VRE		MAQUAT 64-1010N		10324-147
MRSA & VRE		MAQUAT MQ2525M-14		10324-142
MRSA & VRE		MAQUAT 256-NHQ		10324-141
MRSA & VRE		MAQUAT MQ2525-M-CPV		10324-140
MRSA & VRE		MAQUAT 256-1010N		10324-134
MRSA & VRE		MAQUAT A		10324-131
MRSA & VRE		MAQUAT 64 EBC		10324-120
MRSA & VRE		MAQUAT 128 EBC		10324-119
MRSA & VRE		MAQUAT 256 EBC		10324-118
MRSA & VRE		MAQUAT 710-M		10324-117
MRSA & VRE		MAQUAT 750-M		10324-115
MRSA & VRE		MAQUAT 32 MN		10324-114
MRSA & VRE		MAQUAT 64 MN		10324-113
MRSA & VRE		MAQUAT 128 MN		10324-112
MRSA & VRE		MAQUAT  256 MN		10324-108
MRSA & VRE		MAQUAT 10PD		10324-99
MRSA & VRE		MAQUAT 50DS		10324-96
MRSA & VRE		MAQUAT 20-M		10324-94
MRSA & VRE		MAQUAT 64 PD		10324-93
MRSA & VRE		MAQUAT 86-M		10324-85
MRSA & VRE		MAQUAT 7.5M		10324-81
MRSA		MAQUAT 5.5M		10324-80
MRSA & VRE		MAQUAT 615-HD		10324-72
MRSA & VRE		MAQUAT 10		10324-63
MRSA & VRE		MAQUAT 256		10324-56

 

https://www.epa.gov/sites/production/files/2018-01/documents/2018.10.01.listh_.pdf