Let's find out exactly what this dangerous germ called "Superbug" is?

You've probably heard someone talking about these "superbugs" in the newspaper, on TV, or in person? When you hear this name, it really makes you a little scared, doesn't it? What does "superbug" mean? Is this really dangerous? Today, we'll talk about this in detail, very simply, in a way that you can understand.

What is a "superbug"? Simply put...

Simply put, a "superbug" is a type of microbe that is resistant to the drugs we give to treat a disease, especially antibiotics, and that cannot be easily destroyed. These are also called "multidrug-resistant microbes," meaning they are resistant to many types of drugs.

Imagine, you have a bacterial infection and a doctor gives you medicine. Normally, the medicine kills the bacteria. But, if this is a "superbug" type of bacteria, it has "adapted" to the medicine. So even if you give it to it, it won't die. That's when the problem starts. It's like when we go into battle, the enemy is prepared in advance for the weapons we use.

These "superbugs" are most commonly found in bacteria . That is, they are often bacteria that have evolved to be resistant to several types of antibiotics. However, some fungi can also become "superbugs" that are resistant to antifungal medications.

Have you ever wondered why doctors always say, "Take antibiotics exactly as prescribed, for the right amount of time," and "Don't take antibiotics when you don't need them"? The main reason for that is to prevent the growth of these "superbugs."

When pathogens are repeatedly exposed to antibiotics, they find new ways to evade them. It's like a thief waiting to ambush us every day as we walk down the same street. So, if a "superbug" that is resistant to many drugs were to enter our bodies, it could be life-threatening, and even untreatable.

What are the most common types of "superbugs"?

While any bacteria can develop antibiotic resistance, some strains of bacteria often become "superbugs." Here are a few examples:

• `Staphylococcus aureus` (for example MRSA – methicillin-resistant Staphylococcus aureus)
• Carbapenem-Resistant Enterobacterales ( CREs ) and other drug-resistant Enterobacterales. These include bacteria such as Klebsiella pneumoniae, E. coli, Salmonella, and Shigella.
• `Neisseria gonorrhoeae` (the bacteria that causes gonorrhea)
• `Pseudomonas aeruginosa`
• `Acinetobacter baumannii`
• Mycobacterium tuberculosis (the bacteria that causes tuberculosis )
• Streptococcus pneumoniae (the bacteria that causes pneumococcal disease)
• `Campylobacter`
• `Mycoplasma genitalium`
• Bordetella pertussis (the bacteria that causes whooping cough)

Among the fungal infections, Candida auris and Aspergillus fumigatus can also be "superbugs".

But remember this: just because you've been infected with a germ on this list doesn't mean you've developed a "superbug." There are drug-resistant strains of these germs, as well as drug-sensitive (dead) strains.

What are the symptoms of a "superbug" infection?

The symptoms of a "superbug" infection can vary depending on where in your body the infection is. Some common symptoms include:

• Fever
• Chills
• A skin rash, or a patch of skin that is red, discolored, painful, swollen, or filled with pus or fluid.
• Cough
• Shortness of breath
• Chest or abdominal (belly) pain
• Excessive fatigue or drowsiness (`Lethargy`)
• Muscle or joint pain
• Low blood pressure
• Increased heart rate (Tachycardia)
• Hypothermia (low body temperature)

These symptoms can be caused not only by "superbugs" but also by many other infections. So, if you have these symptoms, especially if they don't improve with treatment, see a doctor immediately.

How do these "superbugs" arise?

There are many reasons why "superbugs" become resistant to drugs. Sometimes, it's something that happens naturally. That is, they evolve to live together with other organisms. Other times, bacteria or fungi develop defense mechanisms to block or destroy antibiotics or antifungal drugs.

Especially in hospitals and other healthcare settings, bacteria can become resistant to the antibiotics that doctors often use. Many "superbugs" develop in these settings. Even with proper use of antibiotics, this can be difficult to prevent.

Bacteria can pass their resistance genes (`resistant genes`) to other bacteria that are already there. This is called `horizontal gene transfer`. Also, they can survive antibiotics, reproduce, and pass their genes (along with the ability to resist) to others.

How does a "superbug" infect us?

You can get the "superbug" in these ways:

• By direct contact with someone who is infected or colonized. Some people naturally carry "superbug" bacteria or fungi on or inside their bodies, but they don't get sick. This is called `colonization.' If you carry a germ in this way, you can pass it on to others, and they can get sick.
• By touching objects or surfaces that are contaminated with germs.
• By sharing contaminated items with others. For example, bedding, clothing, medical or sports equipment, towels, razors, or eating utensils.
• Contaminated medical equipment and medical devices in your body (e.g., a central venous line or breathing tube).
• From contaminated food or water and unpasteurized dairy products.

Who is at higher risk of developing a "superbug" infection?

You may be at higher risk of developing a "superbug" infection if you:

• If you have a central venous line, breathing tube, feeding tube, or other tube or device inserted into your body, these can allow the "superbug" to enter your body from outside.
• If you have been taking antibiotics for a long time or are using them frequently. Long-term exposure to antibiotics increases the chance that bacteria will develop resistance. It can also kill off the "good" (non-harmful) bacteria in your body. These "good" bacteria are what keep other bacteria from growing out of control and causing infections.
• If you have an underlying health condition that weakens your immune system, such as HIV infection, blood cancers, or diabetes, or if you have had an organ transplant or stem cell transplant. These conditions make it harder for your body to fight infections.
• If you are hospitalized for a long time or in a long-term care facility. Many "superbugs" are found in healthcare settings.

What are the complications of "superbugs"?

If doctors can't control an infection quickly, it can lead to serious complications. Examples:

• Sepsis and septic shock (a severe response to infection that causes low blood pressure, tissue damage, and organ failure).
• Respiratory failure.
• Loss of infected limbs (amputation).

These are really dangerous situations, aren't they? That's why we need to be so concerned about "superbugs."

How to identify "superbugs"?

If you have symptoms of an infection and they don't get better with treatment, your doctor may think you have a "superbug." They will look for bacteria and fungi in samples of body fluids or tissue, or try to culture them. These samples may include:

• Blood
• Urine
• Stool
• Fluid or tissue taken from a wound
• Phlegm (the secretion that comes from the lungs with a cough - `Sputum`)

If you have any medical devices implanted in your body, or if you have recently been hospitalized, tell your doctor about that as well.

Is there a cure for "superbugs"?

No single drug can cure "superbugs." That's why they're so dangerous. Doctors treat "superbugs" by finding a drug that works against the specific germ that caused the infection. You may need a combination of medications, such as different types of antibiotics, to fight the infection.

In addition, doctors treat skin infections by caring for open wounds. This may include draining the wound and surgically removing infected tissue. They may also remove infected medical devices, such as prosthetic limbs.

Some resistant fungal infections, such as Candida auris, can be treated with antifungal drugs called echinocandins.

What happens if you get a "superbug"?

If you get a "superbug," you may need to be treated for longer than expected or with more than one type of medication. For some people, the infection can become life-threatening. If you have a severe or invasive infection, you will be admitted to a hospital and treated so that health workers can monitor you closely.

If you have a skin infection, your doctor will treat your wounds by surgically removing the fluid from them. They may also prescribe a skin cream or oral antibiotics.

Can you survive a "superbug" infection?

Yes, people recover from "superbug" infections. However, in severe infections or infections that spread to the bloodstream, the mortality rate is high - in some cases as high as 50%. So this is not something to be taken lightly.

When should I see my doctor?

If you have a medical device implanted in your body or if your immune system is weakened, ask your doctor what signs of infection you should watch for. If you have any suspicious symptoms, see your doctor and tell them about them.

Even while you're in the hospital, it's important to maintain good communication with your healthcare team. If you're experiencing symptoms of an infection, such as pain, increased heart rate, weakness, or fever, let them know.

When should I go to the Emergency Department (ETU) ?

If you have any of these severe symptoms, go to the emergency room immediately:

• If the fever is higher than 40 degrees Celsius (103 Fahrenheit).
• Severe pain.
• Seizures.
• Confusion or disorientation.
• Sudden drop in blood pressure (symptoms: weakness, dizziness, fainting).

What questions should I ask my doctor?

It may be helpful to ask your doctor questions like these:

• What treatment options do I have?
• How should I take my medicine?
• When can I expect to get well?
• How did I get this infection?
• What can I do to prevent this type of infection in the future?

Can "Superbugs" be prevented?

The best way to prevent the development of "superbugs" is to use antibiotics only when absolutely necessary.

There are guidelines for healthcare workers to follow to prevent unnecessary antibiotic use. However, there are ways you can contribute to this as well:

• Take all medications as prescribed. If a doctor prescribes antibiotics, take them for the full prescribed duration, even if you feel well. Do not stop halfway through.
• Don't take antibiotics unless you need them. Most colds and other respiratory infections are caused by viruses. Antibiotics won't cure them.

How do we reduce the spread of "superbugs"?

Healthcare workers follow safety and sanitation rules to reduce the risk of hospital-acquired infections (possibly "superbugs"). These include:

• Wash your hands frequently.
• Disinfecting surfaces.
• Ensuring that people are only given antibiotics when they have bacterial infections.
• Sterilization of medical equipment.
• Quarantining (isolating) people with "superbug" infections to prevent them from spreading to others.

Although "superbugs" are common in healthcare settings, they can be spread in many different ways. You can reduce your risk of "superbugs" by following the same practices we follow to protect ourselves from common infectious diseases:

• Keep wounds clean and covered.
• Do not reuse needles (even your own) used to inject non-medical drugs or medications.
• Wash bedding, towels, and clothes frequently at the correct water temperature.
• Use disinfectant to wipe down frequently touched surfaces like light switches, remote controls, and sports equipment.
• Get vaccinated. There are vaccines against many types of bacteria that are "superbugs" like Bordetella pertussis (whooping cough) and Streptococcus pneumoniae (pneumococcal disease).
• Practice good hygiene habits. This includes washing your hands thoroughly, wearing clean, dry clothes, and not sharing your personal items with others.
• Follow safe food practices. This includes storing food properly, cooking meat and fish to a temperature that kills bacteria, and washing or peeling fruits and vegetables before eating.
• Use a condom or dental dam during any sexual intercourse.
• Ask your doctor how long you should keep medical devices (such as catheters) in place, and how to prevent infections while the device is in place.

How common are "superbugs"?

In the United States alone, nearly 3 million people fall ill with antibiotic-resistant bacterial infections each year, and more than 35,000 die from them. This threat is also growing in Sri Lanka.

What is the hardest infection to cure?

Bacteria that have developed resistance to multiple drugs are the most difficult to treat. Infections like MRSA and CREs are often resistant to more than one antibiotic. Therefore, finding an effective drug (or a combination of drugs that work together) can be challenging and time-consuming.

Even though humans haven't invented antibiotics, "superbugs" are still around - that's how they live in nature. However, the way we use antibiotics, especially when we take them unnecessarily, is accelerating their growth.

Finally, things to remember (Take-Home Message)

A "superbug" is a type of germ that can cause serious, difficult-to-treat, and potentially life-threatening infections. If you have symptoms of a bacterial or fungal infection, especially if you've recently been to a hospital or healthcare facility, see a doctor right away. Prompt treatment can reduce your risk of becoming seriously ill.

The most important thing is:

• Only take antibiotics if prescribed by a doctor.
• If you are taking antibiotics, take the prescribed dose for the prescribed length of time. Do not stop halfway.
• Don't ask for antibiotics for viral illnesses like the common cold, they won't help.
• Always maintain good hygiene, especially hand washing.

Following these simple steps will go a long way in protecting us all from this silent enemy called the "superbug." Taking these steps is essential to protect your health and that of society.

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