It has been said that most humans are resistant to change unless it is to their benefit; perhaps other living organisms are the same-save the super bugs. Super bugs (SBs) are so readily adaptable to change that they are thriving. The term "super bugs" is a colloquial reference to a bacterium that carries resistant genes to many antibiotics. The SBs expression also can be used in the case of a bacterium or virus of significantly enhanced virulence. SBs have genetically adapted to form a highly developed resistance to antibiotics. To counteract SBs, we have developed "super antibiotics," our weapons of choice to eradicate and mitigate harm to the human and animal kingdom done by SBs. These SBs are so named because of their virulence, which refers the degree of pathogenicity they can inflict on a given organism. SBs survive through complex adaptive mechanisms; they thrive, survive, and resist our attempts to eradicate them with a vengeance. How these life-threatening organisms escape and evade our attempts to eradicate them are complex, genetically based, and result in mutations that allow the offending organism to survive, multiply, and nullify antibiotics by super resistance.
Because of globalization, travel, "carriage trade medicine" or "medical tourism," and the virulence of SBs, we are now seeing reports that illuminate some disturbing intelligence about the genetic mutations that may make these SBs a new threat. There have been recently published reports about the detection of a new SB in several countries, including the United Kingdom, Australia, Canada, the United States, the Netherlands, and Sweden. Apparently, it is a new gene called the "New Delhi metallo-beta-lactamase (NDM-1)." NDM-1 facilitates the resistance of a wide variety of bacteria and supercharges them to become SBs and resistant to a good number of antibiotics. This resistance is caused by gene transfer mechanisms often referred to as "gene swapping," which essentially makes bacteria like Escherichiacoli resistant to most antibiotics.
The origin and genesis of these mutant SBs seems to be recorded in patients in India and Pakistan who underwent surgical procedures and returned to Britain. It seems that the gene is endemic in India, but may be emerging elsewhere. The Indian medical establishment refutes the claims and is asking the scientific community to be more rigorous in the explanation of the emergence of antibiotic resistance and to not be so quick to charge the Indian medical community. I agree the development of antibiotic resistance is a global issue that some say is akin to global warming.
Every wound care specialist must fully appreciate and understand the concept of antibiotic resistance, owing to the rise in alarming infective organisms that are ubiquitous in the hospital setting. SBs have in some cases become "bulletproof," thwarting our attempts to eradicate them- methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, viruses, fungi, and parasites to name a few.
It is time to return to the basic tenets of combating antibiotic resistance. Work with infectious disease specialists prior to prescribing "super antibiotics" in chronic wound care patients, and ensure isolation and relentless hand washing. The creation of SBs is potentially a global health issue and not an issue for one country or one medical community, but for global priorities in general and for individual wound care practitioners specifically.
"When a man points a finger at someone else, he should remember that four of his fingers are pointing at himself."
-Louis Nizer
Richard "Sal" Salcido, MD
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