How bugs become superbugs

CNN's Elizabeth Cohen explains how superbugs are formed when bacteria become resistant to antibiotics.

Posted: Aug 8, 2018 9:56 PM
Updated: Aug 8, 2018 10:24 PM

In hospitals, one bacterial species is becoming increasingly tolerant to the alcohols used in hand sanitizers, according to research published Wednesday in the journal Science Translational Medicine.

Globally, hospitals use isopropyl or ethyl alcohol-based disinfectants, such as hand rubs, to prevent patients from becoming sick from many germs. These are the same active ingredients found in hand sanitizers available for personal use and at schools -- but that doesn't mean people should give up on them.

The bacterium Enterococcus faecium resides in our guts, but if encountered in a hospital, it can cause various complicated infections affecting the abdomen, skin, urinary tract and blood. This particular bug is a member of the Enterococci family, which ranks as the fourth and fifth leading cause of sepsis, a life-threatening bloodstream infection, in North America and Europe, respectively.

Many hospital-acquired infections have decreased or been kept in check by Australia's strict hygiene practices that rely on alcohol-based hand sanitizers. Yet drug-resistant E. faecium infections have increased in Australian hospitals over time, according to the study authors.

This alarming pattern prompted them to investigate whether E. faecium might be developing resistance to the alcohols used in hand rubs.

Another form of resistance

The researchers analyzed 139 bacterial samples from two Melbourne hospitals collected over 19 years ending in 2015. They studied how well each sample survived when exposed to diluted isopropyl alcohol.

The isolates gathered after 2009 were, on average, more tolerant to the alcohol compared with bacteria taken from before 2004, the researchers discovered. Conducting mice experiments and further analysis, they also saw that alcohol-tolerant bacterial samples harbored several genetic mutations involved in metabolism, which made them better equipped to live in the gut.

Although the results suggest that microbes can adapt to alcohols and other ingredients found in disinfectants, this conclusion cannot be drawn until more research is done, the researchers warn.

"There are two things we are working on," said Tim Stinear, a co-author of the study and professor at the University of Melbourne. "One is understanding exactly how the bacteria are becoming more tolerant. ... The second is what's going on in other parts of the world, and we are working with colleagues around the world to address that."

One-third of all enterococcal infections in Australian hospitals are caused by E. faecium, according to Stinear and his co-authors. Of these, 90% were ampicillin-resistant strains, and half of those were resistant to vancomycin, another common antibiotic. Even when doctors try a higher-grade antibiotic to treat such illnesses, the outcome may be further drug resistance -- and a longer-lasting infection for the patient.

Study co-author Paul Johnson, an infectious diseases professor and director of research at Austin Health in Melbourne, said that when it comes to preventing certain outbreaks, including vancomycin-resistant enterococci, hospitals might need to use more than standard precautions such as hand hygiene.

"We might need to specifically add additional control measures," he said. Such measures could include using an additional bacteria-killing agent, such as chlorhexidine, to sanitize hands in some medical care settings.

True perhaps in hospitals, but the same might not apply to the world at large.

Don't throw away the hand sanitizer

"The bottom line is, this is a really good study," said James Scott, a professor at the Dalla Lana School of Public Health at the University of Toronto.

"It's one of these things that microbiologists thought might happen for a long time, but no one really bothered to test it," said Scott, who did not participate in the research. Now, he said, it's "pretty clear" that alcohol-resistance does happen.

Yet, he added, the results might not translate to the everyday use of hand sanitizers.

"The germs that were tested in this study are really hospital-based germs, not the kind of thing you would encounter in the community routinely," he said. In the community, people use hand sanitizers to kill germs that spread foodborne illness, such as listeria and salmonella.

"The hospital situation is very different," he said, explaining that in the closed environment of a hospital with highly susceptible patients, there's an opportunity for organisms to evolve. "It can lead over time to a growth in resistance."

"Rubbing alcohol has long been used in medicine as a disinfectant for skin surfaces and environmental surfaces," Scott said. "It has been generally thought that rubbing alcohol was fairly safe from the emergence of resistance amid susceptible germs. This interesting and carefully done study refutes that assumption."

Scientists have known for a long time that rubbing alcohol is not a universal disinfectant, because a number of important germs are highly resistant to disinfection by alcohol, he said. One example: "Clostridium difficile, an agent of serious diarrheal disease responsible for hospital outbreaks."

"It is important for people to understand that this study is specifically concerned with one particular germ that is increasingly implicated in hospital-acquired infections," Scott said. "This study really only applies to the specific environment of hospitals, and I'm confident that alcohol-based disinfectants will continue to remain highly effective in general use."

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 149940

Reported Deaths: 3779
CountyCasesDeaths
DeSoto10097104
Hinds9984199
Harrison7116110
Jackson6360119
Rankin5588103
Lee509195
Madison4799106
Forrest383186
Jones357688
Lauderdale3496147
Lafayette326051
Washington3179107
Lamar291550
Oktibbeha245462
Bolivar241384
Lowndes237364
Panola222350
Neshoba2206118
Marshall217250
Leflore205590
Pontotoc199928
Monroe198177
Sunflower191655
Lincoln190865
Warren176857
Tate169851
Union167325
Copiah164140
Pike162658
Yazoo156039
Scott154829
Itawamba152935
Pearl River152167
Alcorn151328
Coahoma150543
Simpson148353
Prentiss146230
Adams141950
Grenada140945
Leake134944
Holmes130861
George125524
Tippah125230
Covington123439
Winston122224
Hancock121139
Wayne117923
Marion116646
Attala113034
Tishomingo109442
Chickasaw107632
Newton105629
Tallahatchie97027
Clay91327
Clarke90553
Jasper82822
Stone77014
Walthall76928
Calhoun75513
Montgomery74525
Carroll72415
Lawrence71814
Smith71316
Yalobusha71327
Noxubee71017
Perry67026
Tunica61019
Greene60322
Claiborne58616
Jefferson Davis57017
Amite54014
Humphreys53619
Benton49318
Quitman4927
Webster44314
Kemper43618
Wilkinson39822
Jefferson35211
Franklin3395
Choctaw3357
Sharkey30917
Issaquena1164
Unassigned00

Alabama Coronavirus Cases

Cases: 244993

Reported Deaths: 3572
CountyCasesDeaths
Jefferson32314500
Mobile19859361
Madison13223148
Tuscaloosa13049154
Montgomery12342236
Shelby1031577
Baldwin873398
Lee775766
Morgan662650
Calhoun6301119
Etowah627666
Marshall627255
Houston525638
DeKalb485536
Cullman439442
Limestone425145
St. Clair419555
Lauderdale407854
Elmore406864
Walker3657111
Talladega351454
Jackson320423
Colbert311942
Blount292240
Autauga273542
Franklin252633
Coffee245415
Dale232654
Dallas226232
Chilton223438
Russell22193
Covington218934
Escambia198331
Chambers176850
Tallapoosa176391
Pike158614
Clarke158419
Marion140236
Winston133023
Lawrence127936
Pickens123518
Geneva12218
Marengo121524
Bibb117917
Barbour117310
Butler116541
Randolph102921
Cherokee102224
Hale97031
Clay91924
Fayette91616
Washington91219
Henry8546
Lowndes79929
Monroe78911
Cleburne77214
Macon73722
Crenshaw71130
Bullock69619
Perry6886
Conecuh68414
Lamar6798
Wilcox63518
Sumter58122
Greene42618
Choctaw42213
Coosa3444
Out of AL00
Unassigned00
Tupelo
Overcast
46° wxIcon
Hi: 53° Lo: 37°
Feels Like: 46°
Columbus
Overcast
47° wxIcon
Hi: 56° Lo: 38°
Feels Like: 47°
Oxford
Overcast
46° wxIcon
Hi: 49° Lo: 32°
Feels Like: 46°
Starkville
Overcast
46° wxIcon
Hi: 51° Lo: 35°
Feels Like: 46°
WTVA Radar
WTVA Temperatures
WTVA Severe Weather