SUPERBUGS Vs. Superman?: The 9 ‘ifs’ that may help

The film Superman premiered in Hollywood in 1978. I watched it in Nigeria in the early 80s and loved it. I was intrigued by the handsome well-built caped man who came from Krypton and could fly at supersonic speed. He could single handedly deal with Villains from all over Space. His arch enemy was the Villain Lex Luther whom he fought and captured at the end of the film. Though in normal life he was a clumsy newspaper reporter called Clark Kent, Superman was the defender of Planet Earth. He performed his super hero duties responsibly despite developing a romantic relationship with a beautiful female colleague, Lois Lane. I have always enjoyed watching Super heroes reigning supreme over Villains.

That is why I wonder why there is no Medical Superman to handle the Villain Superbugs ravaging our medical world today. Why are we constantly been defeated by tiny microscopic Superbugs? What is a Superbug anyway? Superbug is the layman’s terminology for multi-drug resistant bacteria. These are bacteria that are resistant to many forms of standard antibiotics and cause infections that are difficult to treat.

Superbugs have been well documented in Europe, North America and India. It was shown that Superbugs caused an estimated 5000 deaths in the UK in 2012. In the US, they are linked to 2 million cases of illnesses per annum, cause 23,000 deaths and account for healthcare costs of $20billion annually. Methicillin Resistant Staphylococcus Aureus MRSA (shown below) is an example of a superbug.

However, the most recent Superbug in the Medical world is the Carbapeneum Resistant Enterobacteriaceae (CRE). CRE is responsible for the latest superbug attack in America; 7 patients were infected with this superbug, 2 of which are dead and about 179 others are estimated to have been exposed to the bacteria. These patients are believed to have been infected between October 2014 and January 2015 in a UCLA hospital where they underwent endoscopy for the investigation of pancreatic and biliary duct disease. A special duodenoscope manufactured by Olympus Corp. called Q180V was used. The company has since been sued by relatives of infected patients. Though the Food and Drug Administration (FDA) recently approved a superman drug developed jointly by Actavic PLc and AstraZeneca called Avycaz (ceftazidime and avibactam) to combat Superbugs, there are still justifiable fears that this may not be enough.

 What makes this Superbug attack so unique is that these procedures were said to have been done under strict aseptic conditions. The scopes were properly sterilized after each procedure according to manufacturer’s instructions. Patients were not expected to get infected, yet they did. That means the superbugs were able to break through our last line of defense-sterilization of equipment. We seem to be at their mercy now. This much was stated by an infectious disease expert from Duke University, Dr Derrick Anderson when he said there were “no breaks in the disinfection process yet infection arose”. He concluded that there was “no solution presently” to superbugs. Sounds like Lex Luther just gave Superman a sucker punch!

Superbugs get their awesome powers of antibiotic resistance in two ways. First, resistance can be formed from vertical genetic variation through random mutation. Secondly, (and Superbugs love this route of acquiring resistance) resistance is acquired through horizontal transfer of plasmids. These plasmids contain DNA coded against specific antibiotics. When they get into the new bacteria, they are incorporated into the chromosome of the new bacteria. Many of these plasmids contain DNA against different kinds of antibiotics. The end result is the production and proliferation of multi drug resistant bacteria- the Superbugs.

Superbugs seem to be getting the upper hand against the Medical Superman basically because of improper antibiotic use and poor infection control in healthcare facilities worldwide. For instance, doctors have been known to transmit another superbug, Clostridium difficle Infection (CDI) from one patient to another through their unwashed hands. In this case, a simple hand wash with soap and water will help to prevent CDI. 

In the case of the CRE, a simple redesign of the endoscope making it easier to clean properly may be the solution. It may also not be out of place for manufacturers to consider single-use disposable parts when designing scopes.

However, the big question is how do we get Superman to destroy these villains once and for all time? How do we preserve our health and those of future generations? How do we carry out even the most minor surgical procedure without the fear of superbugs hindering recovery? How do we ensure that antibiotics continue to handle bacterial infections successfully?

The solution may lie in implementing the 9 ‘ifs’:

• ·        If patients do not request for drugs every time they visit a Physician
• ·        If patients comply with dosage instructions when they are given antibiotics
• ·        If Physicians do not prescribe antibiotics excessively (one study showed that 30-50% of antibiotic use was inappropriate)
• ·        If there are stricter and enforceable controls for antibiotic use in all nations of the world
• ·        If hospitals comply with infection control techniques 100% of the time
• ·        If the use of sub-optimal dosage of antibiotics in livestock farming is stopped
• ·        If pharmaceutical companies can better control the antibiotic waste water effluents they regularly discharge into the environment
• ·        If pharmaceutical companies will fund more research into discovering newer antibiotics
• ·        If we can develop and promote alternatives to antibiotic therapy e.g. stool transplant, probiotics, cytokines etc

Until we can implement these measures, the Superbugs may continue giving our Medical Superman a torrid time.