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Selected Category: Antibiotic use

Dr. Fishman’s Top 5: Appropriate Antibiotic Use

Categories: Antibiotic use, Healthcare-associated infections

Neil Fishman, M.D.

Neil Fishman, M.D.

Neil Fishman, M.D.

Antimicrobial resistance is one of the most pressing problems and greatest challenges that we will confront during the coming decade. As bacteria and other micro-organisms are becoming more resistant to antimicrobials, our current therapeutic options are dwindling and research and development of new antibiotics is lagging. For the first time since the discovery and introduction of penicillin in the 1940s, we are dangerously close to a return to the pre-antibiotic era.

I believe that antimicrobial stewardship is the best way to improve antibiotic use. The goals of antimicrobial stewardship are to ensure the proper use of antibiotics in order to reduce or stabilize resistance, to optimize clinical outcomes, and to decrease the risk of adverse events. SHEA and IDSA published Guidelines for Antimicrobial Stewardship Programs in 2007, but there are many simple steps practices and hospitals can take to improve antibiotic use without a complex infrastructure. For example:

  • Never treat viral syndromes such as acute bronchitis with antibiotics, even when patients demand therapy.
  • Use fluoroquinolones cautiously. Not only is fluoroquinolone resistance rising at an alarming rate, but this group of drugs causes resistance to many other antibiotics and is associated with the new more virulent strain of C. difficile we are seeing in the United States.

CAUTI– Preventing the Most Common HAI (Part 2)

Categories: Antibiotic use, CAUTI, Healthcare-associated infections

Linda R. Greene, RN, MPS, CIC

Linda R. Greene, RN, MPS, CIC

Linda R. Greene, RN, MPS, CIC

As an infection preventionist who is addressing this issue on a daily basis, I agree with Dr. Gould’s interpretation.

Despite the fact that urinary tract infections( UTI’s) are the most common healthcare-associated infection (HAI’s), they have traditionally not received the same level of attention as have other HAI’s. Most UTI’s are associated with the presence of a urinary catheter. Urinary catheters are used frequently in healthcare settings, however many of these catheters are not necessary and are sometimes inserted without appropriate justification. Often, this leads to overuse and misuse of antibiotics to treat these infections, which can lead to the emergence of drug-resistant bacteria. Because UTI’s can compromise one of the largest reservoirs of multidrug-resistant bacteria in healthcare settings, it is essential that we find ways to minimize their occurrence.

What are we doing about this? The Association of Professionals in Infection Control and Epidemiology (APIC) continues to work on ways to bring science to the bedside. In 2008, we developed a catheter-associated urinary tract infection (CAUTI) elimination guide. This CAUTI guide was developed to serve as a comprehensive tool to questions posed by our members. The APIC elimination guides are developed in sync with guidelines released by CDC, thereby helping to translate evidence into clinical practice and sharing strategies and tools which others have found to be successful.

CAUTI– Preventing the Most Common HAI

Categories: Antibiotic use, CAUTI, Healthcare-associated infections

Dr. Carolyn Gould

The other day, I was watching my colleague Dr. Sanjay Saint on Medscape and began thinking, “How can we better communicate that urinary tract infections (UTIs) are more than just nuisance infections, and that they are preventable?” So, I want to focus this blog post on one of the most common, yet most preventable, of the healthcare-associated infections catheter-associated urinary tract infections (CAUTIs).

In looking at the overall number of healthcare-associated UTIs, I am overwhelmed by both the burden and the myths associated with catheter use. Today, UTIs account for more than 30 percent of HAIs in acute care hospitals, and most of these are caused by urinary catheters. Perhaps the fact that many providers out there still believe that certain conditions, such as incontinence, are best managed with catheters is contributing to the CAUTI burden. The reality is that because infection control measures – including removing catheters as soon as possible – aren’t always followed, CAUTIs are causing illness among patients, longer hospital stays, and unnecessary antibiotic use. And more antibiotic exposure puts patients at greater risk for developing multidrug-resistant organisms and Clostridium difficile infection.

Red Bugs with No Drugs – Part 3: The Need for New Antibiotics — The 10 x ’20 Initiative

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

10 x 20

Richard Whitley, MD, FIDSA
IDSA President

Sadly, the deaths and suffering caused by antibiotic-resistant infections continue to rise around the world, highlighting the urgent need for action. One of the most critical needs is the development of new antibiotics, including those to treat Gram-negative bacterial infections, caused by the “Red Bugs” Dr. Srinivasan discussed in his previous posts.

Recognizing the dangerous imbalance between the dwindling drug pipeline and the need for new antibiotics, the Infectious Diseases Society of America (IDSA) is urging a global commitment to develop 10 new antibiotics by 2020, known as the 10 x ’20 initiative. You can help us in this important effort.

Red Bugs with No Drugs – Part 2

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

Dr. Arjun Srinivasan

So, you find yourself in the horrible situation of having a patient with a Gram-negative infection.  Increasingly, clinicians are getting back reports from the microbiology lab showing pathogens that are resistant to every antibiotic they would normally use to treat a patient.  What do you do when this happens?

First, immediately implement contact precautions (such as gloves and gowns).  Secondly, in some cases you should do active surveillance among the patients who are epidemiologically linked to the case-patient.  By conducting active surveillance, you can identify additional patients colonized with these organisms.  This can help you determine whether you have ongoing patient-to-patient transmission of these bacteria in your facility.   If you detect transmission—meaning that you identify cases among patients with epidemiologic links to your case-patient—vigorously reinforce infection prevention measures until no new cases are identified.

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