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Selected Category: Antibiotic use

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.

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.

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