In this section of the seminar, I will be addressing some of the other negative ramifications of the broad-spectrum antibiotic era. In previous sessions, I discussed increasing microbial resistance, but as one sagacious and somewhat pretentious scientist once said, "as we cover the waterfront, we drown ourselves too." Here are some of the other things that occurred during this broad-spectrum era.

Dr. Regal discusses how the broad-spectrum antibiotic era has caused other risks in hospitals, such as "super infections." (1:06 min)

Another good example of the negative ramifications of the broad-spectrum antibiotic era is something called C. difficile colitis. ile is an opportunistic pathogen. It resides in the bowel of about 3-5 percent of healthy patients. It may be found in 20-30 percent of older or less healthy patients and usually does not cause problems until the flora is upset by antibiotics which once again destroy the balance and cause the C. difficile, the opportunist, to reek havoc upon the bowel and cause diarrhea, toxicity, and even death. This was not even discovered until 1978. Much of the work was done at the University of Michigan, and what we do know is that when you reduce your use of certain broad-spectrum antibiotics, you do indeed reduce the incidence of C. difficile colitis within your hospital or institution.

Another negative ramification of the broad-spectrum antibiotic era is increased pharmaceutical cost, which is a problem in general. For instance, pharmaceutical costs are rising two to three times higher than other healthcare costs--about 15-20 percent per year increase in pharmaceutical costs versus a 5-8 percent rate in healthcare in general. Further, about half of all healthcare cost increases are due to the increase in pharmaceutical costs, and antibiotics are a very big part of that. For instance, in the average hospital, 20-50 percent of all of your costs for drugs are related to antibiotics. They take up a sizable portion of the overall drug budget.

	Discussion
	Among the elderly population, the rising cost of pharmaceuticals is a common concern. {Dis: Should governments allocate funds to offset such costs?}

Contributing factors to resistance
There are numerous factors contributing to multi-resistant bacterial proliferation. Bad infection control practices such as overcrowding and poor sanitation are some examples of these; and these do not only occur in Third World countries. In the United States, in an effort to consolidate services and improve workflow (because of nursing or other staffing shortages) hospitals have closed down areas and have brought patients closer together in the name of cost containment. It is interesting that in modern healthcare, hospitals and medical centers are doing things to make us more vulnerable to multi-resistant pathogen proliferation than ever before.

Other factors include medically induced immunosuppressive states--patients with bone marrow transplants, patients with solid organ transplants--longer life for patients with autoimmune diseases who are on potent immunosuppressant drugs. Another factor lies with the aging population. In general, patients are living longer, but each time hospitals help them fight off an infection, the patients develop resistant flora to whatever antibiotic they were on. The resistant flora remains after the antibiotic is stopped. In these scenarios, a patient may auto-infect themselves (through translocation) with the new resistant organism or spread it to other patients (often via the hands of a health care professional caregiver), especially if he or she has fecal or urinary incontinence. So again, in helping people live longer lives, hospitals have, actually, made patients more vulnerable to advancing microbial resistance.