Translator: Reiko Bovee Reviewer: Ellen Maloney
Thank you.
I am going to start with a story of a 35-year-old mother of two,
who presents to the emergency room with acute appendicitis.
She goes to the operating room,
and the surgeon gives her a single dose of antibiotic for surgical prophylaxis,
before he makes the incision.
She does fine post-op.
At discharge, he gives her two prescriptions:
one for pain meds, and one for a 10-day course of antibiotics,
just in case she develops an infection.
Day five of antibiotics,
she develops diarrhea, a known side effect of any antibiotic.
But by day eight, the diarrhea is severe.
She has a high fever, acute abdominal distension, and severe pain.
She comes back to the emergency room,
where she is diagnosed
with Clostridium difficile diarrhea,
or C. diff and Toxic megacolon:
a surgical emergency.
She is taken to OR and dies.
Death from diarrhea?
Every antibiotic carries the risk of C. diff diarrhea.
But this was actually preventable
because the 10-day course of antibiotics was unnecessary.
It was prescribed "just in case."
In 1942, Sir Alexander Fleming discovered the first antibiotic, penicillin,
a miracle life-saving drug.
But he forewarned if we misused, overused, or abused antibiotics,
the bacteria would begin to mutate and create, what we call "superbugs."
Superbugs are bad bacteria
that are resistant to many antibiotics,
or in some cases, every single antibiotic we have.
You see our bodies have an ecosystem: it's called the "microbiome."
There's good bacteria that are susceptible to antibiotics shown in blue,
and there's bad bacteria that are resistant to antibiotics in pink.
So, when you take an antibiotic,
antibiotic kills the good susceptible bacteria,
and leaves behind the resistant,
and it begins to multiply and developsinto a superbug.
What's even more concerning is you can acquire a superbug
without ever taking an antibiotic.
The FDA states over 80 per cent of antibiotics in the United States
are actually given to feed animals, not because they have infections.
Antibiotics are used in tiny doses in animals as growth promoters.
A cow with a superbug can actually give that superbug to human by two ways;
either by direct contact with the animal or by eating meat.
The Centers for Disease Control has stated:
"We are no longer to use antibiotics as growth promoters in animals."
That is why you're seeing
a lot of fast food chains and restaurants serving antibiotic-free meat.
The Centers for Disease Control released this Threat Report
to increase awareness of some of these superbugs
such as MRSA, C. diff, and drug-resistant gonorrhea,
just to name a few.
The current worldwide death from superbugs annually
is 700,000 people a year.
That is seven football stadiums of death.
The United Kingdom commissioned a world economist to forecast,
if we just stay the road and continue using antibiotics like we are right now,
what would the death toll be by 2050?
The answer is 10 million people a year,
more than cancer and traffic accidents combined.
I can give you a lot of statistics on this,
but this topic is very up close and personal to me.
As an infectious disease clinical pharmacist for over 27 years,
I've traveled the world to six continents and every state in the United States
teaching the responsible use of antibiotics and trying to change
the behavior of prescribing them "just in case" there's an infection.
And what I've learned is the world is one.
Ebola taught us every superbug is a plane ride away.
So, maybe it's when I went to Rio and was met with this headline.
This beautiful 20-year-old woman
acquired her first urinary tract infection.
The doctor gave her a three-day course of Cipro; that should do the trick.
Except it didn't.
She was infected with a superbug
that was resistant to Cipro and every antibiotic available,
and she died at age 20 from her first UTI.
Or maybe it's when I went to Vietnam.
The hospitals are so overcrowded
there's actually two patients per bed, spreading a superbug one to the next.
Or maybe it's when I went to India.
I go to the market , and realize anybody can buy any antibiotic
for anything, even the common cold which is caused by a virus.
Antibiotics only work against bacteria.
Or maybe it's when I go to Africa and the poorest of poor walk miles
to see a healthcare provider only to arrive at the clinic and be told,
"There are no antibiotics to give you."
Or maybe it's right here in Columbus, Ohio,
where our hospitals admit patients every day with superbugs.
The decades of overuse, misuse, and abuse of antibiotics
has created these superbugs.
You might think, "Well, this is really interesting, kind of scary,
but I've actually never taken an antibiotic.
I'm not really sure this impacts me."
Let me show you several reasons it impacts every one of us.
Maybe you're the 25 year old, pregnant with your first child
and need to have a C-section.
Without an effective antibiotic to give you before that incision is made,
you have a one in 100 chance of dying from your C-section.
Or maybe, you are that career athlete and had a career-ending injury,
and you need a joint replacement.
Without an effective antibiotic to give you before that incisions is made,
you've a one in six chance of dying from your surgical procedure.
Or maybe you're the diabetic with the external insulin pump
or dialysis patient with a shunt.
All these devices put you at risk of acquiring superbugs.
Maybe it's your father or your grandfather in the hospital.
The Centers for Disease Control has identified
33 per cent of antibiotics written for urinary tract infections
in the hospital actually have an error.
They're either the wrong dose, the wrong duration, or the wrong drug.
In the outpatient setting, 30 per cent of antibiotics given are unnecessary.
Patients pressure their doctors to prescribe them.
If you're admitted to a US hospital, you have a one in seven chance
of getting a superbug: we give it to you.
If you're in acute care setting, nursing home: one in four chance.
What is the answer?
The solution is antibiotic stewardship.
Stewardship is overseeing something worth protecting,
and that something is an antibiotic.
They will save your life when used appropriately.
Antibiotics are societal drugs;
the more we use them, the less effective they become.
And one person's use can directly impact someone else.
So, let's see how everybody can be a steward of antibiotics
as the consumer.
You feel a cold coming on, you feel terrible, you call your doctor.
"Doctor, I feel awful. I don't have time to be sick. I need a Z-Pak."
That's without stewardship.
With stewardship, "Doctor, I feel a cold coming on.
Here's my symptoms. What would you recommend I take?
You see I am concerned about the overuse of antibiotics,
and the risk of C. diff and superbugs.
I am an antibiotic steward."
Or you go to pump your gas, and you see this sign:
Free antibiotics! Limited time only.
(Laughter)
Without stewardship, you pump your gas.
With stewardship, you have a little chat with that store manager.
(Laughter)
This sends the wrong message.
You see, I'm concerned about the overuse of antibiotics
and the risk of C. diff and superbugs.
I am an antibiotic steward.
Maybe you go to your favorite restaurant, you order a steak.
Without stewardship, you just eat it.
With stewardship, you ask your waiter, "Do you serve antibiotic-free meat here?
You see I am concerned about the overuse of antibiotics on animals,
and the risk of C. diff and superbugs.
I am an antibiotic steward."
Maybe you are the patient in a hospital.
Your healthcare team comes to examine you.
And without stewardship, you smile at them.
With stewardship, you ask,
"Have you all washed your hands before you touch me?
(Laughter)
I'm concerned about acquiring C. diff or a superbug
when I am in your hospital.
I am an antibiotic steward."
Or maybe you are the healthcare provider, the doctor, the nurse, or the pharmacist,
prescribing antibiotics.
It requires behavior change to unravel the decades of handing them out
just in case there's an infection.
Who remembers when smoking was considered macho -
the Marlboro Man -
or even glamorous, until we learned it actually kills us.
[Hello, My Name is: DEATH]
When we prescribe antibiotics unnecessarily,
we create superbugs that can actually kill us.
So, I'm going to finish with a story.
My daughter was a college athlete and broke her nose.
Upon surgical repair, the surgeon meets me and hands me two prescriptions:
one for pain meds and one for a 10 day course of antibiotics.
I looked and said, "Could we try a different approach?
How about if I monitor my daughter for signs and symptoms of infection?
I'm concerned about the overuse of antibiotics
and the risk of her acquiring C. diff or a superbug."
I am an antibiotic steward, and I hope all of you will be too.
Thank you.
(Applause)