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Selected Category: Antibiotic use

ResistanceMap: Visualizing the Progression of Antibiotic Resistance

Categories: Antibiotic use, Antimicrobial Resistance

Ramanan Laxminarayan, Ph.D.

Ramanan Laxminarayan, Ph.D.

Guest author - Ramanan Laxminarayan, Ph.D.
Director of the Center for Disease Dynamics, Economics & Policy and an associate research scholar and lecturer at Princeton University.

Through Get Smart, CDC has raised awareness of antibiotic resistance as a serious public health concern that requires action. But where is resistance changing and at what rates?  Is any region at particular risk?  Are there patterns to its emergence that vary among different combinations of bacteria and antibiotics?

It is with these questions in mind that Extending the Cure has launched ResistanceMap—a new tool for visualizing resistance over time.  Our beta version of ResistanceMap takes four common antibiotics (imipenem, methicillin, trimethoprim sulfa, and ciprofloxacin) and charts the resistance of common bacteria (Acinetobacter baumannii, Staphylococcus aureus, and Escherichia coli) over the first decade of the 21st century.  Each progression shows how resistance has changed from year to year, by U.S. census divisions.

How much antibiotic use is too much?

Categories: Antibiotic use, Antimicrobial Resistance, NHSN

Elizabeth S. Dodds Ashley, PharmD, MHS, BCPS

Elizabeth S. Dodds Ashley, PharmD, MHS, BCPS

Guest author - Elizabeth Dodds Ashley, PharmD, MHS, FCCP, BCPS
Associate Director of Clinical Pharmacy Services and Antimicrobial Stewardship Pharmacist – University of Rochester Medical Center, Rochester, NY

Although this question sounds simple on the surface, answering it is one of the biggest challenges to stewardship programs both old and new.  Unlike our infection prevention colleagues, antimicrobial stewards lack a uniform tool to measure and report antimicrobial utilization in a consistent way that facilitates benchmarking with similar institutions. Knowing how utilization compares with other centers is an invaluable tool in a field such as antimicrobial stewardship where utilization is driven by trends in resistance and changed by emerging infections making goal utilization an ever moving target.

Let’s Take an Antibiotic Time Out

Categories: Antibiotic use, Clostridium difficile, Gram negatives, Healthcare-associated infections

Arjun Srinivasan MD

Author - Arjun Srinivasan, MD
CDC – Medical Director, Get Smart for Healthcare Program

Over the past 2 years, I have brought together experts on antibiotic resistance to discuss how CDC can assist in efforts to improve antibiotic use in hospitals and nursing homes. My colleagues have published numerous studies demonstrating that inappropriate antibiotic use in hospitals and nursing homes results in increased resistance, worse patient outcomes, and increased costs.  It is also helping drive the national epidemic of Clostridium difficile infections.  This year, we have watched as deadly new mechanisms of antibiotic resistance were discovered in U.S. hospitals, mechanisms that will undoubtedly challenge our healthcare system and affect patient safety (see NDM-1, VIM). Clearly, we have a serious problem.

Those initial discussions with colleagues resulted in an expansion of CDC’s Get Smart programs, which target antibiotic use in outpatient clinics and pediatrician’s offices, to include a comprehensive program targeting inpatient settings.  This week, CDC launched the Get Smart for Healthcare program aimed reducing inappropriate antibiotic use in hospitals and nursing homes.  The foundation of this program is the concept that everyone plays a role in improving antibiotic use.

Antibiotic Prescriptions – Where you Live may Matter

Categories: Antibiotic use, Healthcare-associated infections

Get Smart Week

Get Smart: Know When Antibiotics Work

Author – Lauri Hicks, DO
CDC – Medical Director, Get Smart: Know When Antibiotics Work

As an infectious diseases physician and the medical director of CDC’s Get Smart: Know When Antibiotics Work program, I’ve repeatedly encountered patients with antibiotic-resistant infections. When antibiotics fail to work, the consequences are longer-lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and stronger medications that may have side effects.

Much of this resistance is due to the repeated and often unnecessary use of antibiotics. Inappropriate prescribing and antibiotic use is particularly common during cough and cold season. Colds, most coughs and bronchitis, sore throats (except strep throat), and some ear infections, collectively known as upper respiratory infections, or URIs, are the main culprits behind inappropriate antibiotic treatment. Did you know that URIs account for over half of all antibiotics prescribed by office-based physicians? Most URIs are caused by viruses, and antibiotics are completely ineffective for treatment of viruses. Healthcare providers cite diagnostic uncertainty (uncertainty whether an illness is viral or bacterial), time pressure, and patient demand and expectations as the primary reasons why antibiotics are over-prescribed.

VIM: New Route, Same Destination

Categories: Antibiotic use, Gram negatives, Healthcare-associated infections

Alexander J. Kallen, MD, MPH

Alexander J. Kallen, MD, MPH

Author – Alexander Kallen, MD, MPH
Medical Officer
CDC’s Division of Healthcare Quality Promotion

Last week my colleague Dr. Brandi Limbago addressed the issue of carbapenem-resistant Enterobacteriaceae (CRE) and specifically enzymes called KPCs and NDM-1s that are causing the bacteria to become resistant to last-resort antibiotics. Today, CDC released a report about another enzyme causing CRE. This one is called VIM (Verona integron-encoded metallo-beta-lactamase). VIM has been found previously in a number of countries including Greece where this patient had been transferred from. View recommendations for surveillance and prevention here.

Just as Dr. Limbago mentioned last week, these enzymes are new routes to the same destination: CRE. All types of CRE are significant and emerging public health problems, regardless of their route to resistance or their country of origin. The fact is that we live in a very small world, medically speaking, and it’s not surprising that these organisms are moving from country to country. This situation simply reinforces the need for better antibiotic stewardship, transmission prevention and overall healthcare-associated infection (HAI) prevention in every hospital and practice – today.

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