Candi Shearen, RN, BC, CIC:
Stories of Antibiotic Use and Resistance

My aunt, Sister Mary, passed away in a nursing home after developing Clostridium difficile infection. The infection started after she was treated unnecessarily with antibiotics for what was presumed to be a urinary tract infection (UTI). Sister Mary was very healthy for most of her life and she rarely took any type of medication. She lived for 97 years.

I think our biggest challenges with antibiotic prescribing is still education of the public, staff at long-term care facilities, assisted living facilities, and group homes, staff and physicians at emergency departments, hospitals, and clinics. Beyond the lack of education, there isn’t enforcement for those that prescribe when it is not necessary.

I know that Sister was placed on antibiotics for UTIs at least 3 times in the several months before her death. After the second and third rounds of antibiotics, she started with watery stools. After that, she continued having watery stools, even without an antibiotic to precede it. Her symptoms were vague, tired and weak, ‘just didn’t feel right’. She also fell a few times from being weak. After her second bout with watery stools, the facility did place her in strict contact precautions [to prevent transmission to other residents] since they discovered through culture that she had Clostridium difficile (C. diff). She was not allowed out of her room and her roommate was moved out, so she had little interaction with anyone. She was very active prior to the isolation, but being in isolation took her social life away from her too. She passed away about a month after she let me know she was ill. She did have other co-morbidities, but this diagnosis certainly contributed to her death.

Personally, I have found myself to be an advocate for NOT using antibiotics, unless they are absolutely necessary, such as fitting the clinical symptoms and lab/radiology confirmation. I have the advantage of being the educator for the company [Welcov Healthcare] I work for and for the Basic Infection Prevention Program with APIC-MN (Association for Professionals in Infection Control-Minnesota). This allows me the platform to teach many healthcare workers about the need to optimize the use of antibiotics due to resistance, adverse effects, and the cost of antibiotic misuse.

We are growing more resistant bugs and running out of antibiotics. We are surely moving to where we won’t have any antibiotics available for when we truly need them. My dream is that all providers will use antibiotic stewardship and get off this road we are headed - towards the ‘post-antibiotics’ era.

I would love to see that we develop methods to better differentiate bacterial from viral infections.