The Real and Evolving Threat of Superbugs: A Primer

pillsinspaceJust how super is the latest superbug? The good news is that the infected U.S. patient has recovered. The bad news:  mcr-1, the resistance gene identified in this strain of E. coli, has brought us another frightening step closer to a “post-antibiotic” era.

In recent years, antimicrobial resistance among Gram-negative bacteria (E. coli, Klebsiella, Pseudomonas, Acinetobacter, Salmonella, and others) has been a growing public health concern. Most of the increase in resistance has been the result of mobile genetic elements that can easily transfer resistance from one bacterium to another, allowing bacteria to “catch” antibiotic resistance from one another.

To make matters worse, resistance enzymes are often packaged together. One genetic “cassette” can carry multiple resistance determinants, thereby spreading resistance to more than one class of antibiotics at the same time.

Early on, we relied on the carbapenem class of antibiotics to treat infections caused by multidrug-resistant (MDR) organisms such as the “ESBLs” (extended-spectrum beta-lactamase-producing organisms). But carbapenemase-producing organisms soon developed, and resistance to carbapenems spread quickly.

In 2009, the emergence of a “super” kind of carbapenem resistance gene, ndm-1 (New Delhi metallo-beta-lactamase) was found to be highly resistant to many antibiotic classes, including:

  • the carbapenems and other beta-lactams (penicillin derivatives and cephalosporins)
  • the fluoroquinolones (ciprofloxacin, levofloxacin, et al)
  • the aminoglycosides (gentamicin, amikacin, et al).

These antibiotic classes include the main drugs used to […]

2016-11-21T13:01:11-05:00June 6th, 2016|infectious diseases, Nursing, Public health|1 Comment
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Not a Nurse but Her Mother Was, and Now It Really Matters

June_Refl_Illustration Illustration by Lisa Dietrich for AJN

The loss of Emily Cappo’s mother, a competent and supportive parent and an accomplished nurse, leaves an enormous gap in her daughter’s life. Then her own son gets sick.

Cappo writes about these events in “I’m Not a Nurse, But My Mother Was,” the Reflections essay in the June issue of AJN.

Without her mother to turn to for help and guidance, Cappo has no idea how she’ll handle the situation. “There I was,” she writes,

the nonmedical person in my family, the person who hated blood and needles, being thrown into a situation demanding courage, stamina, and role modeling.

But we rise to the situation that presents itself, if the stakes are high enough. Cappo discovers what many nurses already know: the nurses who care for her son make all the difference in his care, and provide her with essential support as well. […]

2016-11-21T13:01:11-05:00June 3rd, 2016|narratives, Nursing, patient engagement, Patients|0 Comments
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AJN Hits the Road: From Wall Street to New Orleans

AJN’s editor-in-chief watches the nursing profession get a chance to ring the New York Stock Exchange bell, is exhorted to courageous action by critical care nurses in the Big Easy, records a podcast conversation with two nursing leaders.

May is always busy with professional meetings. I attend many of them, scouting out issues, trends, and authors. And then, of course, there’s Nurses Week, with its own flurry of activities.

NYSE JJ Podium Group 1 courtesy of Diane Mancino

Nurses ring the bell! This Nurses Week included a first for nursing: recognition by the New York Stock Exchange (NYSE). Johnson & Johnson’s Campaign for Nursing’s Future was invited to ring the closing bell of the NYSE on May 12, the official end of Nurses Week and the birthday of Florence Nightingale. Andrea Higham and Lorie Kraynak of the J&J campaign, along with Sue Hassmiller (Robert Wood Johnson Foundation), Beverly Malone (National League for Nursing), Diane Mancino (National Student Nurses Association), and other representatives of nursing organizations crowded the bell platform to watch the CFO of Johnson & Johnson ring the bell. I watched from the trading floor along with other nurses, nursing students, and organization […]

2016-11-21T13:01:11-05:00May 31st, 2016|Nursing, nursing perspective|0 Comments
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AJN in June: IPV, Late Effects of Breast Cancer Treatment, Nurse Activists, More

AJN0616 Cover Online

This month’s cover photo evokes the isolation faced by victims of intimate partner violence (IPV). According to Karen Roush, PhD, RN, lead author of the study in this issue that reports on the perceptions of rural health care providers who care for these victims, “ [i]solation is one of an abuser’s biggest weapons,” especially for those who live in rural areas.

Health care providers are positioned to provide support for victims of IPV, but knowledge and practice gaps get in the way. For more on this topic, read this month’s original research CE, “Intimate Partner Violence: The Knowledge, Attitudes, Beliefs, and Behaviors of Rural Health Care Providers.”

Some other articles of note in the June issue:

CE Feature: “Late and Long-Term Sequelae of Breast Cancer Treatment.” More than 12% of women will be diagnosed with breast cancer at some point in their lives; 78% of them can be expected to survive for at least 15 years. There are more than 2.8 million breast cancer survivors in the United States and as many as 90% of them report physical problems that can reduce functional ability, produce or exacerbate emotional problems, negatively affect body image, and diminish quality of life.

This third article in a series on cancer survivorship care from the […]

2016-11-21T13:01:12-05:00May 27th, 2016|Nursing, nursing perspective|0 Comments
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Recent Decline in U.S. Opioid Prescriptions: Good News But Some Concerns

by frankieleon/ via flickr by frankieleon/ via flickr

It was widely reported in the past week that there have been steady declines in the number of opioid prescriptions in the U.S. for the past three years, with the declines the steepest in some of the states considered to have the worst opioid misuse crises.

This is good news, suggesting that efforts to address some problem areas like renegade pain clinics prescribing for profit, patients who go from doctor to doctor seeking opioid prescriptions, and the diversion of legitimate opioid prescriptions may be starting to bear fruit.

A balanced overview of the situation can be found in this New York Times article. The authors also acknowledge that patients in pain are now facing new hurdles to pain relief, quoting the director of one prominent medical school’s program on pain research education and policy: “The climate has definitely shifted. . . . It is now one of reluctance, fear of consequences and encumbrance with administrative hurdles. A lot of patients who are appropriate candidates for opioids have been caught up in that response.”

Much of the reporting on the opioid epidemic lumps all people who take opioids into one big statistical brew. While startling and alarming numbers about overdoses from legal and illegal opioids steal the headlines, little media and scholarly analysis focuses on the lower likelihood […]

2016-11-21T13:01:12-05:00May 26th, 2016|health care policy, Nursing, nursing perspective, pain management, patient experience, patient safety, Patients|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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