January 4, 2021
COLUMBIA, MO. – Christina Fuhrman is haunted by a memory: the image of her little pearl lying pale and listless in a hospital bed and tied to an IV to keep her moisturized in the fight against a superbug infection.
“She survived by the grace of God,” said Fuhrman of the disease that afflicted her eldest child in this central Missouri city nearly five years ago. “She could have become septic quickly. Her condition was almost critical. “
Pearl fought against Clostridium difficile, or C. diff, a type of antibiotic-resistant bacteria known as a superbug. A growing body of research shows that antibiotic overuse and abuse in children’s hospitals – what health professionals and patients should know better – helps fuel these dangerous bacteria that attack adults and increasingly children. Doctors fear that the covid pandemic will only lead to stronger overprescription.
A study published in the journal Clinical Infectious Diseases in January found that 1 in 4 children given antibiotics in U.S. children’s hospitals were given the drugs inappropriately – the wrong types, or for too long, or when they weren’t necessary.
Dr. Jason Newland, a pediatric professor at Washington University in St. Louis who co-authored the study, said this was likely an underestimate given that the research involved 32 children’s hospitals that were already working together on the proper use of antibiotics. Newland said the country’s 250+ children’s hospitals need to do better.
“It’s irresponsible,” added Fuhrman. In connection with parents who beg for antibiotics in pediatricians’ offices, “just a monster” arises.
Using antibiotics when not needed is a long-standing problem, and the pandemic “put a little gas on the fire,” said Dr. Mark Schleiss, Professor of Pediatrics in the University of Minnesota Medical School.
Although fear of Covid-19 means fewer parents are taking their children to doctor’s offices and have skipped some routine visits for their children, children are still receiving antibiotics through telemedical visits that do not allow for in-person exams. Research has shown that more than 5,000 children infected with the coronavirus were hospitalized between the end of May and the end of September. If symptoms suggest a bacterial infection above the coronavirus, doctors sometimes prescribe antibiotics that won’t work on viruses until tests rule out bacteria.
At the same time, Newland said, the requirements for caring for patients with Covid are taking time away from so-called “stewardship” programs, which aim to measure and improve the prescription of antibiotics. Often such efforts include training courses for health professionals to learn how to use antibiotics safely, but the pandemic has made these antibiotics difficult to take up.
“There’s no doubt about it: we’ve seen additional use of antibiotics,” Newland said. “The impact of the pandemic on antibiotic use will be significant.”
Habits encourage the growth of superbugs
Antibiotic resistance occurs through random mutation and natural selection. The bacteria most susceptible to an antibiotic die quickly, but surviving germs can pass on resistant traits and then spread. The process is driven by the prescription of habits that lead to high antibiotic use.
A March study in the journal Infection Control & Hospital Epidemiology found that the rate of antibiotic use among patients in 51 children’s hospitals ranged from 22% to 52%. Some of these drugs treated actual bacterial infections; others were given in hopes of preventing infection or when doctors didn’t know what was causing a problem.
“I hear a lot about antibiotic use in ‘just in case’ scenarios,” said Dr. Joshua Watson, director of the Antimicrobial Administration Program at Nationwide Children’s Hospital in Ohio. “We underestimate the disadvantages.”
Newland said that each specialty in medicine has its own culture around the use of antibiotics. For example, many surgeons routinely use antibiotics to prevent infection after surgery.
Outside of hospitals, doctors have long been criticized for prescribing antibiotics too often for conditions like ear infections, which sometimes go away on their own or can be caused by viruses that antibiotics fail to counteract.
Dr. Shannon Ross, Associate Professor of Pediatrics and Microbiology at the University of Alabama, Birmingham, said not all doctors were taught how to use antibiotics properly.
“A lot of us don’t realize we’re doing it,” she said of overuse. “It’s kind of not knowing what you’re doing until someone tells you.”
All of this is driving the growth of numerous superbugs in the population of these hospitals. Numerous studies, including one published in the Journal of Pediatrics in March, cite the increase in children with C. diff, the cause of gastrointestinal problems. A 2017 study in the Journal of the Pediatric Infectious Diseases Society found cases of a certain type of multi-drug resistant Enterobacteriaceae in American children increased by 700% in just eight years. And a steady stream of research points to the persistent prevalence in children of the more popular MRSA, or methicillin-resistant Staphylococcus aureus.
Superbug infections can be extremely difficult – and sometimes impossible – to treat. Doctors often have to turn to strong drugs with side effects or give drugs intravenously.
“It’s getting more and more worrying,” said Ross. “We had patients we couldn’t treat because we didn’t have antibiotics” that could kill the germs.
Doctors say the world is approaching a “post-antibiotic era,” where antibiotics no longer work and frequent infections can be fatal.
A monster unleashed
Superbugs caused by overuse of antibiotics put everyone at risk.
Like her daughter, Fuhrman suffered from C. diff infection, who fell ill after taking antibiotics after a root canal in 2012. While they kill harmful germs, antibiotics can also destroy those that protect against infection. Fuhrman rode his bike in and out of the hospital for months. When she finally got better, she tried to avoid antibiotics and never gave them to her daughter.
That’s because antibiotics affect your microbiome by wiping out bad germs and the good germs that protect your body from infection.
Perle’s first symptoms of C. diff appeared about three years later, around 20 months of age. Fuhrman noticed that her daughter had a lot of bowel movements. The mother eventually found pus and blood in her daughter’s stool. One day, Pearl was so pale and weak that Fuhrman took her to the emergency room. She was discharged, developed a fever, and returned to the hospital.
Doctors treated Pearl with Flagyl, a broad spectrum antibiotic. But two days after the last dose it went downhill. The infection had returned. She only recovered after going to the Mayo Clinic in Rochester, Minnesota for a fecal microbiota transplant, during which her father gave her a healthy donor stool through colonoscopy.
Since her family’s ordeal, Fuhrman has been trying to raise awareness of superbugs and the overuse of antibiotics. She is a board member of the Peggy Lillis Foundation, a C. diff education and advocacy organization, and has testified before a presidential advisory committee in Washington, DC about superbugs and antibiotic stewardship.
In March, the Centers for Medicare & Medicaid Services required all hospitals to document that they had antibiotic stewardship programs.
One approach, Schleiss said, is to limit antibiotics by “saving our most magical orbs for the most desperate situations”. Another option is to stop antibiotics after 72 hours, for example, after verifying that patients need them. In the meantime, doctors are calling for more research into the use of antibiotics in children.
Fuhrman said hospitals should do everything possible to stop superbug infections. The stakes are enormous, she said, pointing to Pearl, now a 7-year-old first grader who loves to wear a pink hair bow and paint her tiny fingernails with a rainbow of pastel colors.
“Antibiotics are great, but they need to be used wisely,” said Fuhrman. “The problem with the superbugs is here. It’s in our back yard now and it’s only getting worse. “
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.
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