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The Dental Professional’s Role in the Prevention of Antibiotic Resistance and Adverse Antibiotic Reactions

Course Number: 614

Impact of Multi-drug Resistant Bacteria on Patients and Practitioners

The podcast “America Dissected,” Dr. Abdul El-Sayed, former Executive Director of the Detroit Health Department and Assistant Professor of Epidemiology at Columbia University, discusses the personal impact of antibiotic resistance.28 The episode, entitled, “Superbugging Out,” interviews a patient, Addie Hoates from Tucson, Arizona, who was infected with methicillin-resistant Staphylococcus aureus (MRSA) and developed sepsis and disseminated intravascular coagulation (DIC). An avid softball player and a healthy 11-year-old, she developed symptoms that quickly progressed to a life-threatening illness and required her to be in the intensive care unit (ICU) for a prolonged period of time. During her time in the ICU she developed multiple subsequent nosocomial infections with antibiotic resistant bacteria, each of which required treatment with a series of increasingly-powerful second-, third-, and fourth-line antibiotics.28 She stayed in the ICU for 5 months and ultimately required a lung transplant after pneumonia caused by Enterobacter aerogenes. Prior to the lung transplant, she required treatment with Polymyxin E (Colistin), a drug of last resort for multidrug-resistant Gram negative infections.28 The side effects of this antibiotic therapy left Addie with severe immune deficiency and resulted in a stroke and vision loss, severe weight loss, permanent paresthesia, and motor damage.28 While such outcomes may be uncommon, the economic, emotional, and quality of life toll that these infections took on Addie and her family is devastating and highlights the high stakes of emerging antibiotic resistance.

In a U.S. surveillance report of hospital-associated blood borne infections, the incidence of MRSA being present increased from 22-57% between 1995 and 2001.29 In response to these statistics, physicians and hospitals instituted changes to infection control processes and prescribing practices. Between 2005 and 2017, the U.S. Department of Veteran’s Affairs medical centers experienced a 43% decline in all S. aureus infections and a 55% decrease in MRSA infections.30 This report is encouraging as it demonstrates that alterations in workplace infection control and prescribing patterns can positively impact infection rates. This is particularly important given recent data that suggest that the types of antibiotic resistant bacteria that were once significantly more common in hospital associated infections are increasing in proportion of community associated infections.31,32