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Selected Category: Antimicrobial Resistance

Success in Controlling Outbreaks in an Intensive Care Unit Using CDC Toolkit Interventions

Categories: Antimicrobial Resistance, Gram negatives, Healthcare-associated infections

Dr. Kyle Enfield

Dr. Kyle Enfield

Guest Author: Kyle B. Enfield, MD,
Assistant Professor of Medicine,
Assistant Hospital Epidemiologist,
Medical Director, Medical Intensive Care Unit,
University of Virginia

Infections due to carbapenem-resistant Enterobacteriaceae (CRE) are on the rise globally. These infections have limited therapeutic options, and invasive infections due to CRE are associated with a mortality rate upwards of 40 percent. A scary statistic for patients!

My institution, the University of Virginia Health System, identified our first case of CRE in August 2007. We had low level transmission with periods of improvement; however, in January 2010 we noted both an increase in CRE transmission among patients in the surgical intensive care unit (SICU), as well as a cluster of infections caused by a nosocomial pathogen new to the unit and our institution – extensively drug-resistant Acinetobacter baumannii (XDR-AB).

It was critical that we address this potential issue head-on in order to ensure positive patient outcomes and do our best to limit our institution’s exposure to CRE. After initial attempts to control these concurrent outbreaks of multidrug-resistant Gram negative pathogens using reinforced standard infection control practices failed, we implemented a bundled set of infection control interventions aimed to assess the prevalence of CRE and XDR-AB colonization or infection in the unit. The collective set of measures we implemented became recommended practice in the Centers for Disease Control and Prevention 2012 Carbapenem-resistant Enterobacteriaceae Toolkit. The interventions were developed by units in collaboration with Infection Prevention and Control and Environmental Services.

Despite Progress, three-quarters of a million infections threaten hospital patients each year

Categories: Antimicrobial Resistance, BSIs, CAUTI, CLABSI, Clostridium difficile, Healthcare-associated infections, Long Term Care (LTC), NHSN, State HAI Prevention

National and State Healthcare-associated Infections Progress Report. This report is based on 2012 data, Published March 2014

National and State Healthcare-associated Infections Progress Report. This report is based on 2012 data, Published March 2014

Despite Progress, three-quarters of a million infections threaten hospital patients each year
National and state data detail threat of healthcare-associated infections and opportunities for further improvements.

CDC released two reports today – one, a New England Journal of Medicine (NEJM) article detailing national healthcare-associated infection estimates, and the other an annual report on national and state-specific progress toward U.S. Health and Human Services HAI prevention goals. Together, the reports show that progress has been made in the effort to eliminate infections that commonly threaten hospital patients, but more work is needed to improve patient safety.

The NEJM article updates the burden numbers for healthcare-associated infections in hospitals.  On any given day, 1 of every 25 patients had 1 or more infections related to their hospital stay.   That means about 722,000 infections a year related to medical care.  One of every 9 patients who gets an infection will die during their hospitalization.

This article sounds the alarm about threats we need to address now.  It tells us that lung infections, gut infections, surgical infections and infection from urinary catheters are harming the most patients.

Some of the top pathogens attacking patients are: 

  • C. difficile, or deadly diarrhea,
  • Staph, including the drug-resistant type known as MRSA,
  • a family of germs known as Enterobacteriaceae, that includes CRE the “nightmare bacteria,”

The second report, CDC’s National and State Healthcare-associated Infection Progress Report, includes national and state-by-state summaries of infection types that are commonly required to be reported to CDC. The Progress Report looked at data submitted to CDC’s National Healthcare Safety Network (NHSN), the nation’s healthcare-associated infection tracking system.   On the national level, the report found a:

  • 44 percent decrease in central line-associated bloodstream infections between 2008 and 2012
  • 20 percent decrease in infections related to the 10 surgical procedures tracked in the report between 2008 and 2012
  • 4 percent decrease in hospital-onset MRSA bloodstream infections between 2011 and 2012
  • 2 percent decrease in hospital-onset C. difficile infections between 2011 and 2012
  • 3 percent increase in catheter-associated urinary tract infections

At the federal and state levels, CDC uses this information to find facilities that need help and target resources where they are most needed.

To access both reports and to see the updated healthcare-associated infection data, see CDC’s website: www.cdc.gov/hai.

Watch a new video on Healthcare-Associated Infections.

Preserving Antibiotics Key to Protecting Patients

Categories: Antimicrobial Resistance, Healthcare-associated infections

Rear  Admiral Boris D. Lushniak, MD, MPH

Rear Admiral Boris D. Lushniak, MD, MPH

Author: Rear Admiral Boris D. Lushniak, MD, MPH
Acting Surgeon General

Antibiotics are powerful tools for fighting illness and disease, but some of these drugs are being rendered less effective due to overprescribing, misuse, and bacterial evolution.

Many of our advances in medical treatment, such as chemotherapy and transplants, depend on antibiotics’ ability to fight bacterial infections. These drugs also help manage infections that happen as a result of surgery. Unfortunately, bacteria learn in a very short time how to outsmart antibiotics. Resistant bacteria can easily multiply, spread, and share their resistance with other bacteria.

A recent report from the Centers for Disease Control and Prevention found that more than two million people in the U.S. become sick every year with antibiotic-resistant infection. At least 23,000 die as a result. Antibiotic-resistant infections can also add considerable, and many times avoidable, costs to patients and the healthcare system due to longer illness, lost productivity, and more expensive hospital stays.

The President’s budget, which was released on Tuesday, includes $30 million for a domestic initiative to establish a robust infrastructure that can detect antibiotic resistant threats and protect patients and communities.

Antibiotics are among the most commonly prescribed drugs used in human medicine, yet up to 50% of all the antibiotics used in hospitals are not needed or are incorrectly prescribed. Each one of us can help limit antibiotic resistance by changing the way we use antibiotics.

Sometimes the Safest Prescription is “Wait and See”

Categories: Antibiotic use, Antimicrobial Resistance

Adam L. Hersh, MD, PhD

Adam L. Hersh, MD, PhD

Guest Author – Adam L. Hersh, MD, PhD
Assistant Professor of Pediatrics
Division of Pediatric Infectious Diseases
University of Utah

Get Smart About Antibiotics Week is a great opportunity to call attention to a priority that we all share: preserving the effectiveness of antibiotics for the future. Doctors and other practitioners on the front-lines of ambulatory care may become frustrated when they hear the way they practice medicine is partly to blame for the urgent threat of antibiotic resistance.

For those of us working in ambulatory care settings, it is a really busy and demanding job, and for many patients with upper respiratory tract infections (URIs), it’s hard to know who has a bacterial infection and who doesn’t. This year, Get Smart About Antibiotics Week is featuring the publication of Principles of Judicious Antibiotic Prescribing for Pediatric Upper Respiratory Tract Infections in the journal Pediatrics. It discusses the importance of diagnostic certainty and reviews the clinical criteria practitioners should use when determining the likelihood of a bacterial infection.

There are established and stringent clinical criteria that should be applied to justify an antibiotic prescription for the key URIs in pediatrics that are potentially caused by bacteria. Many bacterial URIs will resolve on their own without antibiotic treatment. And the serious and justifiably feared complications of URIs (such as mastoiditis as a complication of otitis media) usually cannot be prevented by early antibiotic therapy anyway. All of this is important to consider as our understanding continues to grow about the harms antibiotics can cause.

Antibiotic overuse not only contributes to increased resistance but also avoidable adverse drug events including serious allergic reactions, cardiovascular problems and chronic conditions such as eczema, asthma, inflammatory bowel disease and obesity. Doctors want to do what is safe and in their patients’ best interests. When there is a considerable degree of uncertainty regarding the diagnosis for patients with URIs, sometimes the safest thing to do is to “wait and see.”

The Value of an Infectious Diseases Specialist

Categories: Antimicrobial Resistance, Clostridium difficile, Healthcare-associated infections

Steven Schmitt, MD, FIDSA

Steven Schmitt, MD, FIDSA

Guest Author – Steven Schmitt, MD, FIDSA
Chair of the Infectious Diseases Society America’s Clinical Affairs Committee and infectious diseases physician at Cleveland Clinic

We’re all well aware that infection is a major problem among hospitalized patients, sometimes arriving with infection as a reason for admission and sometimes developing infection in the hospital.  In either case, infection is among the top causes of death in the hospital and hospital-acquired infections affect one in 20 patients. Many of these infections are resistant to antibiotics, making them extremely difficult to treat. So what is the answer?  Get patients the type of care they deserve – in this case, treatment provided by physicians who are experts in infectious diseases.  A recent study published in Clinical Infectious Diseases– based on Medicare data from nearly 130,000 hospitalized patient cases – provides strong evidence that infectious diseases expertise is invaluable. 

To quantify the value of ID physicians, we studied the records of patients who had at least one of 11 common types of infections, including Clostridium difficile, which the CDC recently named as one of the top three urgent threats in its landmark antibiotic resistance report.  Other infections included: bacteremia, central line associated bloodstream infections (CLABSI), bacterial endocarditis, HIV/opportunistic infections, meningitis, osteomyelitis, prosthetic joint infections, septic arthritis, septic shock and vascular device infections. Matching patient characteristics, we compared the outcomes of those who had seen an ID physician and those who had not. 

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