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 […]

2016-11-21T13:01:11-05:00June 6th, 2016|infectious diseases, Nursing, Public health|1 Comment
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Zika Virus Update: Epidemiology, Sexual Transmission, Pregnancy

By Betsy Todd, MPH, RN, CIC, clinical editor

A close view of a repellent product being sprayed on a person's hand in Brasilia, Brazil, 27 January 2016. The Brazilian government announced that repellent products will be given for free to pregnant women registered in the assistance programs to avoid Zika contagion. EPA/FERNANDO BIZERRA JR. Mosquito repellant being sprayed on a person’s hand in Brazil. EPA

Zika virus is now being actively transmitted in 42 countries, primarily in the Americas and on islands in the South Pacific. As of April 13th, there had been 358 travel-associated cases reported in the U.S., including 31 pregnant women.

While there are as yet no locally acquired U.S. cases, local transmission has been established in several U.S. territories (primarily, Puerto Rico). Travel-associated cases are expected to continue in the U.S., almost certainly leading to eventual limited local transmission.

Transmission. Most cases of Zika virus infection have been vector-borne—that is, they resulted from the bite of an infected mosquito. […]

2016-11-21T13:01:17-05:00April 20th, 2016|infectious diseases, Nursing, Public health|11 Comments
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What to Know About Zika Virus

By Shawn Kennedy, AJN editor-in-chief. Accompanying map via PAHO/WHO.

The media is full of headlines and photos about the recent increase in the number of Brazilian children born with microcephaly, thought to be due to maternal exposure to the Zika virus. If you’re like most nurses, you’ve had family members and friends asking you about it, especially if they’re considering a winter escape to the Caribbean or Mexico. Here are some resources and information to help you stay up to date so you can provide your patients (and families and neighbors) with evidence-based information.

2016-cha-autoch-human-cases-zika-virus-ew-3

Zika basics. Zika virus was first discovered in 1947 in monkeys in the Zika forest of Uganda and the first documented case in humans was in 1952. An outbreak on Yap Island in Micronesia in 2007 showed that it had spread beyond Africa. The virus is spread by the Aedes mosquito, the same mosquito that transmits yellow fever, dengue, and chikungunya.

Outbreaks of Zika have been spreading northward from Brazil through the Americas since 2014. (See above PAHO/WHO map of confirmed cases, 2015-2016.) While most transmission is believed to occur via mosquito bites, according to the CDC, “Perinatal, in utero, and possible sexual and transfusion transmission events have also been reported. Zika virus RNA has been identified in asymptomatic blood donors during an ongoing outbreak.”

Symptoms and course are similar to those of other […]

2016-11-21T13:01:31-05:00January 26th, 2016|infectious diseases, nursing perspective|0 Comments
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Nurses and Latent TB Infection

By Betsy Todd, AJN clinical editor, MPH, RN, CIC

Mantoux skin test/CDC PHIL Mantoux skin test/CDC PHIL

Are you “PPD positive”?

In December, a California maternity nurse was diagnosed with active tuberculosis. More than 1,000 people, including 350 infants, may have been exposed. In infants, tuberculosis can be hard to diagnose and is more likely than in newly infected adults to progress to active disease and to disseminate to extrapulmonary sites. Therefore, a course of isoniazid was recommended for each of these exposed infants, as well as for any parents, visitors, or staff who tested positive after the exposure.

Some of the details of this incident weren’t released to the media. In my experience, active infection in a health care worker who has not recently traveled to a TB-endemic area is almost always the result of reactivated latent infection. That was the case in a similar exposure more than 10 years ago, when a New York City maternity nurse exposed more than 1,500 infants and adults to active tuberculosis.

And in three of the largest TB exposure investigations on which I’ve worked, the index cases were nurses in oncology, transplant, and the ED whose latent tuberculosis infection progressed to active infection. In these three cases, neither the RNs nor their own primary care providers connected their persistent febrile respiratory infections with […]

2016-11-21T13:01:33-05:00January 18th, 2016|infectious diseases, Nursing, nursing perspective|0 Comments
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Inside an Ebola Treatment Unit: A Nurse Shares Her Experiences in Liberia

By Sylvia Foley, AJN senior editor

“It is extraordinarily difficult to establish an IV line in a dehydrated patient by generator-powered light while double gloved, with one’s goggles fogging.”—Deborah Wilson

Author Deborah Wilson at the Foya ETU cemetery. Photograph by Marcos Leitão.In one of this month’s CE features, “Inside an Ebola Treatment Unit: A Nurse’s Report,” author Deborah Wilson offers readers a rare look from the frontlines of the 2014 Ebola epidemic. Her stories about her patients and colleagues are as compelling as they are informative. Here’s a short overview of the article:

In December 2013, the first cases of the most recent outbreak of Ebola virus disease (EVD; formerly known as Ebola hemorrhagic fever) emerged in the West African nation of Guinea. Within months the disease had spread to the neighboring countries of Liberia and Sierra Leone. The international humanitarian aid organization Médecins Sans Frontières (MSF; known in English as Doctors Without Borders) soon responded by sending staff to set up treatment centers and outreach triage teams in all three countries. In August 2014, the World Health Organization declared the outbreak an international public health emergency.

In September 2014, the author was sent by MSF to work as a nurse in an Ebola treatment unit in Foya, Liberia for five weeks. This article describes her […]

2017-07-27T14:39:21-04:00December 11th, 2015|infectious diseases, narratives, nursing perspective|4 Comments
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