Blog | Wednesday, September 18, 2013

QD: News Every Day--CDC defines scope of antibiotic resistance, outlines what health care providers can do


At least 2 million people in the U.S. become infected with antibiotic-resistant bacteria, and at least 23,000 people die each year as a direct result, the CDC announced. Almost 250,000 people who are hospitalized get Clostridium difficile each year, and its associated diarrhea kills at least 14,000 people each year.

Also, antibiotic resistance adds $20 billion in excess direct health care costs, with additional costs to society for lost productivity as high as $35 billion a year, the agency said in a press release.

Up to 50 percent of all the antibiotics prescribed for people are not needed or are not prescribed appropriately, the agency said in a report, Antibiotic Resistance Threats in the United States, 2013, which presents the first snapshot of antibiotic-resistant infections that have the most impact on human health.

The threats are ranked in categories: urgent, serious, and concerning, according to seven factors: health impact, economic impact, how common the infection is, a 10-year projection of how common it could become, how easily it spreads, availability of effective antibiotics and barriers to prevention.

Infections classified as urgent threats include carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile.

Some of the infections classified as serious include methicillin-resistant Staphylococcus aureus , drug-resistant Streptococcus pneumoniae, drug-resistant tuberculosis, multidrug-resistant Acinetobacter, drug-resistant Campylobacter, Enterobacteriaceae, vancomycin-resistant Enterococcus, multidrug-resistant Pseudomonas aeruginosa and drug-resistant Shigella.

Those listed as concerning include vancomycin-resistant Staphylococcus aureus, erythromycin-resistant Group A Streptococcus and clindamycin-resistant Group B Streptococcus.

Antibiotic uses in animals are also contributing to the problem, according to Steven L. Solomon, MD, FACP. “Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed. These drugs are a precious, limited resource—the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow.”

Four core actions to fight antibiotic resistance include preventing infections and the spread of resistance, tracking resistance patterns, antibiotic stewardship, and developing new antibiotics and diagnostic tests. Specifically, the CDC said, health care providers can take actions protect patients against antibiotic-resistant infections:
• Follow all necessary infection control recommendations, including hand hygiene, standard precautions and contact precautions.
• Diagnose and treat resistant infections quickly and efficiently. Make sure to follow the latest recommendations to ensure you are prescribing appropriately.
• Only prescribe antibiotics when likely to benefit the patient, and be sure to prescribe the right dose and duration.
• Be sure to clearly label dose, duration, and indication for treatment, and include appropriate laboratory diagnostic tests when placing antibiotic orders, to help other clinicians caring for the patient to change or stop therapy when appropriate.
• Take an antibiotic time out, reassessing therapy after 48-72 hours. Once additional information is available, including microbiology, radiographic, and clinical information, a decision can be made on whether to continue the same therapy.
• When transferring patients, ensure the other facilities are notified of any infection or known colonization.
• Keep tabs on resistance patterns in your facility and in the area around your facility.
• Make sure that patients understand how to protect themselves with vaccines, treatment, and infection control practices such as hand washing and safe food handling.