Aggressive action is needed now to keep new resistance from developing and to prevent the
resistance that already exists from spreading.
2 million hospitalized patients contract a
Healthcare Associated Infection (HAI),
resulting in approximately 100,000
deaths. In September 2013, the CDC
released new evidence of emergent
antimicrobial resistance threats and categorized them into categories of urgency.
According to the new report, at least 2
million people become infected with bacteria that are resistant to antibiotics and
at least 23,000 people die each year as a
direct result of these infections.
It is standard practice for many surgical procedures to administer
antibiotic prophylaxis to reduce the risk of a surgical site infection.
However, with this routine practice comes potential risk for antimicrobial resistance. Hospitals are notorious over-users of antibiotics, many
of which are unnecessary, such as those used to “treat” viral infections
or blood culture contaminants.
The CDC has identified three bacteria that have reached critical
threat level: Clostridium difficile (C. difficile), Carbapenem-resistant
Enterobacteriaceae (CRE), and Drug-resistant Neisseria gonorrhoeae.
Several other multi-drug resistant organisms such as MRSA
were also identified as serious
threats to society. In addition,
almost 250,000 people each
year require hospital care for
Clostridium difficile infections.
In most of these infections, the use of antibiotics was a major contrib-
uting factor leading to the illness. At least 14,000 people die each year
in the United States from C. difficile infections. Many of these infections
could have been prevented.
Antibiotic-resistant infections add considerable and avoidable
costs to the already overburdened U.S. healthcare system. In most
cases, antibiotic-resistant infections require prolonged and/or costlier
treatments, extend hospital stays, necessitate additional doctor visits
and healthcare use, and result in greater disability and death compared
with infections that are easily treatable with antibiotics. The total cost
of antibiotic resistance to the U.S. economy has been difficult to calculate to date.
Estimates vary, but have gone as high as $20 billion in excess direct
healthcare costs, with additional costs to society for lost productivity as
high as $35 billion a year.
The use of antibiotics is the single most important factor leading to
antibiotic resistance around the world. Antibiotics are among the most
commonly prescribed drugs used in human medicine. However, up to
50% of all the antibiotics prescribed for people are not needed or are
not optimally effective as prescribed. Antibiotics are also commonly
used in food animals to prevent, control, and treat disease, and to promote the growth of food-producing animals.
The use of antibiotics for promoting growth is not necessary, and
the practice should be phased out. Because of the overlap of the use of
antibiotics in both medical and consumer settings, hospitals must be
even more judicious with the use of these powerful pharmaceuticals.
Many facilities establish a restrictive protocol of available antibiotics
that is closely based on the facility’s antibiogram. This practice effectively limits the inappropriate use of drugs known to cause resistance at
the specific institution.
The other major factor in the growth of antibiotic resistance is the
spread of resistant strains of bacteria from person to person, or from
the non-human sources in the environment, including food.
There are four core actions that the CDC has identified to fight
these deadly infections:
• Preventing infections and preventing the spread of resistance.
• Tracking resistant bacteria through the electronic medical record
and also the duration of the
• Improving the use of
today’s antibiotics, including
a comprehensive antimicrobi-
al stewardship campaign that
is hard-wired into the culture
of the hospital.
• Promoting the development of new antibiotics and developing
new diagnostic tests for resistant bacteria. In addition, hospitals must
also implement rapid identification technologies for quickly identifying
these high risk microorganisms, and then placing the affected patients
into the appropriate type of isolation.
Bacteria will inevitably find ways of resisting the antibiotics that are
developed, which is why aggressive action is needed now to keep new
resistance from developing and to prevent the resistance that already
exists from spreading.
Hospitals should collaborate with the facility’s clinical pharmacy
department, infection preventionists, and pharmacy and therapeutics
committee to closely monitor trends and take action as necessary to
reduce the risk for resistance.
Dr. Hudson Garrett,
"Bacteria will inevitably find ways of resisting
Clinical Affairs, PDI
the antibiotics that are developed, which is why
aggressive action is needed now."