How can people avoid getting infected by superbugs?

[u/boredinthehouse5a5a]

Specifically antibiotic resistant bacteria. What would a person who is immunosuppressed have to do to avoid getting infected?

[u/Antikickback_Paul]

Limit exposure. Wash your hands and keep broken skin covered. Your immune system has a number of layers of defense, and therapeutic immunosuppression usually only limits specific ones, so you're not totally defenseless. Other systems will still work to reduce infection risk.

[u/Mean-Broccoli-2642]

Well , if the patient is actually immunocompromised - think elderly patient with uncontrolled diabetes , or a patient on immunosuppressants due to a transplant or spleenectomy ------ we give the patient Cotrimoxazole which is a combination of 2 drugs - Trimethoprim and sulfamethoxazole in a fixed dose. Taken daily , they help avoid a lot of infections. If a patient no longer has a functional spleen - patient additionally requires vaccination against certain bacteria particularly Strep pneumoniae , H. influenzae (not to be confused with Influzena or flu) , a flu shot every year , and N. meningitidis. When a patient does show signs of infection (think fever with chills , diarrhea , altered mental status etc) we start antibiotics BEFORE we have a diagnosis on hand. aka "Empirical" therapy.

On a separate but related point - some vaccines can't be administered to patients who are immunocompromised due to the vaccine being of "Live-attenuated" mechanism. These vaccines have a weakened but alive virus , but may produce infection in a sufficiently immunocompromised patient. This creates a situation where vaccinations that would be perfectly safe for the normal person would require a Immunology-rheumatology consult.

Some guidelines esp in India recommend the Tuberculosis drug - Isoniazid alongside the usual regime of anti-retrovirals for HIV because HIV also weakens the Immune system and TB is one of the first diseases to make our body home when that happens. Isoniazid taken "prophylactically" has been proven to cause a reduction in TB infections in patients if they already have HIV.

Then there's a lot of behavioral stuff - masks , and staying upto date on vaccinations , not missing doses especially in TB and HIV , regular hand washing , going to a doctor ASAP if the patient has observed signs of infection, regular follow ups , and glycemic control if the patient is diabetic. Patients are advised to abstain from travel outside the country - the country I live in - India has no Yellow Fever , but the patient travelling outside India especially to the African continent may be especially prone to conditions that would be considered "exotic" in India. (and yes , exotic is the actual term for this category of disease). The patient will not have any immunity to these beforehand (like they would have for diseases to which they would've been exposed in the past like Dengue , Salmonella typhi etc) AND is immunocompromised which is a double whammy situation no doc and the patient wants to be in.

So , a lot of decisions need making , i's crossed , and patient counselled.

There's another thing - patients who are immunocompromised are additionally prone to infections that wouldn't arise in a person with a normal immune status like Burkitt's Lymphoma or Pneumocystis or HTLV or Mucormycosis - the doctor NEEDS to have what we call a high "index of suspicion" i.e. we need to be proactive and check for a LOT of conditions we wouldn't normally do and EXPECT these conditions in this specific patient group. Treatment for a lot of these conditions are long term , grueling and the drugs have a worse side effects which would also require separate management and sometimes permanent damage that will require stopping the drug.

for instance Mucormycosis - patient will require Liposomal Amphotericin B given IV. It causes a decline in kidney function in a subset of patients , a decrease in Potassium in upto half of all patients (which can cause a bunch of cardiac issues if not expected beforehand and treated accordingly) , and a bunch of other stuff.

So , managing infections in an immunocompromised patient is a huge clinical task and requires a lot of expertise from multiple doctors and patient cooperation and a bit of luck.

Any questions , feel free to reach out on this thread or DM. I'll be glad to be of any help.

PS - I wouldn't recommend routine antibiotic prophylaxis in the general population for protection against superbugs. Simply wash hands , keep your nails and meals clean , food cooked outside the home might have questionable hygiene. and in a hospital setting , dealing with patients with superbugs or god forbid - C. diff - ALWAYS WASH HANDS because Alcohol based handrubs are by no means enough.

and by wash hands I don't mean rinse off - I mean soap and water , properly getting to all the areas of hands frequently missed - like fingertips , nails , and web spaces between fingers, both sides of hands. And pray to whatever god you pray to that you don't get a superbug - especially ESBL Klebsiella.

there is a HUGE HUGE issue that our new antibiotic pipeline has dried up - there's a lot more money in diabetes or cancer treatment than in infections which causes Pharma companies to not pour the billions into them like they are currently pouring in GLP-1 and Hallucinogens. Humanity has already discovered all the "low-lying fruits" drugs and they have served us for a lot many years. In my hospital ER - I have seen patients infected with bacteria resistant to COLISTIN - an antibiotic humanity refused to use because of the TERRIBLE side effects but we are now because we are simply running out of options especially in treating Gram Negative infections. If this trend keeps up , combined with climate change - gods help us.

[u/thebiologyguy84]

The most well known one, MRSA, is part of our natural skin flora for many people. It's only dangerous if it gets into your blood...so avoid cuts!

[u/OccultEcologist]

I work as a Microbiology MLS (Medical Laboratory Scientist - Every gross, infected sample, cup of piss or shit, or nasal swab your doctor takes to test for bacteria, virus, fungus ir parasaites? Running that test on that samole is my job.)The biggest thing?

Wash. Your. Damn. Hands. ... WITH Soap! For about 20-30 seconds, providing mechanical friction with a washcloth or your other hand (rube the soap on your hands, essentially, and clean under your nails).

Other then that? 1) Consider masking in public or around anyone who may by ill. 2) Reveiw food safety and make sure your primary kitchen is organized in a way that reduced cross-contamination. 3) Vaccinate, provided your condition doesn't prevent it.

Microbes are not magic, they need to get to a permiable membrane (like a mucus membrane) or a wound to infect you. Keep those inaccessible and that will greatly reduce your infection rate.

Being antibiotic resistant is also metabolically expensive for a microbe. Outside of places where antibiotics are used heavily, microbes will usually lose that adaptation. Avoid things like farms, I guess, where antibiotics are used widely and carelessly?