Bacteria and Resistance In People with

Antibiotic resistance results from or eliminate the effectiveness of changing in ways that make or other agents used to treat . those no longer useful. Resistance is a common yet problematic With antibiotic resistance, bacteria are issue in treating pulmonary now able to survive the use of these exacerbations or infections in people drugs meant to kill or weaken them. This with Cystic Fibrosis (CF). Not all is an example of acquired resistance. bacteria are bad. However, there are Bacteria may also have intrinsic or some that can cause infections. As natural resistance. bacteria are exposed to antibiotics over time, resistance may develop, and the What is intrinsic resistance and number of antibiotics we have to kill the what are some examples of bacteria decreases as well. Thus, it is bacteria with this type of important to learn what causes antibiotic resistance and ways to prevent it. resistance?

*Words in bold italics are defined in the Intrinsic resistance is when bacteria are Glossary section resistant to antibiotics naturally, without having prior exposure to antibiotics. What are bacteria? This can be a problem in terms of

treatment, since the number of Bacteria are antibiotics for these bacteria may be limited. that live in and around us. They An example of bacteria with intrinsic may be helpful, but resistance is Burkholderia cepacia (bur- sometimes may cause infections like COLD-air-ee-ah sa-PAY-sha). , , or pulmonary exacerbations. What are some examples of What is an antibiotic? bacteria that can acquire resistance? An antibiotic is a term for a or other substance used to kill or slow the growth The most common bacteria that can of bacteria. acquire or develop resistance is aeruginosa (soo-da- What is antibiotic or drug MOE-nus A-ridge-a-NO-sa). resistance? Psuedomonas can develop resistance to several antibiotics. Another bacteria is

Staphylococcus aureus (STAFF-ee-loe- Antibiotic or drug resistance is the result KOK-us OR-i-us). When resistance of bacteria changing in ways that reduce

1 develops, it is commonly called MRSA What are the antibiotics that for methacillin (METH-a-SILL-in) bacteria can develop resistance resistant or ORSA for (OX-a- to? SILL-in) resistant . Bacteria can

develop resistant How does resistance develop? to just about any antibiotic. Below The most common way resistance is are the most acquired is by exposure to antibiotics. commonly used ones to treat an exacerbation or . For example, every time you take a course of antibiotics, you are “exposing” • Beta-Lactams: the bacteria to those antibiotics. e.g. / Each time bacteria are “exposed” to (Zosyn) antibiotics, they can change in a way that the antibiotics are no longer e.g. (Fortaz) effective. e.g. (Maxipime) Another way of acquiring resistant e.g. (Primaxin) bacteria is through contact with other people or equipment when not using • : appropriate standard and contact e.g. and TOBI precautions. This is why hand washing, e.g. and , and washing of respiratory equipment is very important. Also, • Quinolones: standing at least 3 feet away from other e.g. (Levaquin) people with CF is important. e.g. (Cipro)

How fast does resistance develop? What do the different terms

With antibiotic exposure, resistance mean, like resistance, or generally develops overtime. The length sensitive, etc? of time depends on the bacteria and the antibiotic, which can range from one Often times, a sputum culture is treatment course to several. obtained during a hospitalization or clinic visit to see what bacteria you may Do resistant bacteria ever go have and what antibiotics can be away? effective in fighting it. The terms below are used in the “ Report”

to indicate if a particular antibiotic will be Unfortunately, if you have resistant effective. bacteria, it generally does not go away, and is very difficult to eradicate or kill completely.

2 between patients. For example Sensitive using gloves, and gowns when Means that the bacteria are still direct contact is expected. “sensitive” to the effects of antibiotics (2) Droplet precaution reduces the and therefore can be killed or weakened risk of of large- by them. particle droplets which requires close contact since droplets do Intermediate not remain suspended in the air Means that the bacteria is between and generally travel only short sensitive and resistant to the effects of distances, usually 3 ft or less, antibiotics and the antibiotics may no through the air. For example, longer be effective in killing the bacteria masks would be used. (3) Airborne precaution reduces the Resistant risk of of Means that the bacteria are “resistant” infectious agents that may remain to the effects of antibiotics. When suspended in the air for long bacteria are resistant, they are no longer periods of time, like . killed or weakened by the antibiotics. Masks that filter out small The bacteria are considered resistant, particles are used. when at least one major class of antibiotics is no longer effective in killing If you are put in “isolation,” it is for your the bacteria. and other patient’s protection as well to prevent the spread of bacterial or Multi-Drug Resistant antibiotic resistance. Means that the bacteria are resistant to at least two major classes of antibiotics. How Can Antibiotic Resistance be prevented? Pan-Resistant Where the bacteria are resistant to all By using antibiotics appropriately the major classes of antibiotics. This means for you to take your antibiotics exactly as prescribed or What is Isolation? instructed, even if you feel you no longer need to take the antibiotic. It is a method for infection control to prevent the spread of infection or By preventing resistant bacteria between patients. In the spread of addition to standard precautions, resistance isolation is also called transmission- This means that based precautions. Gowns, gloves, and you should: masks are also a necessary part of - Cover your isolation. mouth and nose when There are three types of isolation: coughing or (1) Contact precaution is to most sneezing. commonly used to reduce the risk - Wash and dry your hands or use an or transmission of bacteria alcohol-based hand gel.

3 - Limit contact with other people with Standard precautions – designed to CF or stay at least three feet from reduce the risk of transmission of others with CF microorganisms from both recognized and unrecognized sources of infection and applies to all patients receiving care in a hospital. For examples wearing gloves Glossary when handling , body fluids, secretions, or mucous membranes, or wearing a gown. Acquired Resistance – refers to when bacteria change in ways that reduce or eliminate the effectiveness of antibiotics used to treat infections Resources

Infection Control – refers to policies and For more information on preventing procedures used to minimize the risk of antibiotic resistance, see the Cystic spreading infections, especially in hospitals Fibrosis Foundation Website Brochure and health care facilities on “Stopping the Spread of Germs.” http://www.cff.org/living_with_cf/patient_ Microbiology Report – reports results of and_family_education.cfm antibiotics tested on bacteria; tells whether a bacteria is sensitive, intermediate, or For more information about antibiotic resistant to antibiotics tested resistance, see the Center for Diseases Control Website MRSA – stands for -resistant http://www.cdc.gov/drugresistance/gene Staphylococcus aureus. ral

ORSA – stands for oxacillin-resistant For more information about isolation, Staphylococcus aureus. standard and contact precautions, see the Center for Diseases Control Website Pneumonia – or infection of http://www.cdc.gov/ncidod/hip/ISOLAT/I the lungs solat.htm

Pulmonary exacerbation – worsening of pulmonary symptoms such as increased , sputum production, chest congestion, on exertion or exercise

Sinusitis – inflammation of the sinuses. Sinuses are the hollow areas in the skull around your nose.

Sputum culture – Sputum is material Contributing Authors coughed up from the lungs and spit out through the mouth. A culture of the sputum Jane Kriengkauykiat, Pharm.D. is done to find and identify the Anti-Infective Research Fellow causing an infection by University of Southern California placing it in a medium under conditions that Los Angeles, CA allow it to grow. If a microorganism is found, testing is done to determine which Debbie Benitez, R.N., M.S.N., A.C.N.P. antibiotics can weaken or kill the bacteria Pulmonary Nurse Practitioner and thus will be used to treat the infection. University of Southern California Los Angeles, CA

Paul Beringer, Pharm.D. 4 CF Associate Director of Research University of Southern California Los Angeles, CA