This digitally colorized scanning electron micrograph shows four magenta-colored, spherical methicillin-resistant Staphylococcus aureus bacteria in the process of being phagocytized by blue-colored human white blood cells.
Pathogens that no longer respond to the medications developed to kill them cause more than 2 million illnesses and at least 23,000 deaths each year in the United States, according to the CDC. In addition, Clostridium difficile, a common health care-associated infection (HAI), caused nearly half a million illnesses(www.nejm.org) in 2011, and an estimated 15,000 people die each year from the infection.
Nowhere is this problem more rampant than in the nation's hospitals, nursing homes and other health care facilities. To address it, the CDC released a Vital Signs report(www.cdc.gov) on Aug. 4 that projected an increase in drug-resistant infections and illness caused by C. difficile in U.S. health care facilities in the absence of an immediate coordinated effort between these facilities and health departments to improve infection control and antibiotic prescribing practices.
"Antibiotic-resistant infections in health care settings are a growing threat in the United States, killing thousands and thousands of people each year," said CDC Director Tom Frieden, M.D., M.P.H., in a press release.(www.cdc.gov) "We can dramatically reduce these infections if health care facilities, nursing homes and public health departments work together to improve antibiotic use and infection control so patients are protected."
- An Aug. 4 CDC Vital Signs report projected a national spike in drug-resistant infections and illness caused by Clostridium difficile absent an immediate coordinated effort between health care facilities and health departments.
- The agency's mathematical modeling projects such an approach could prevent up to 70 percent of life-threatening carbapenem-resistant Enterobacteriaceae (CRE) infections for five years.
- The CDC will invest $264 million through its Antibiotic Resistance Solutions Initiative to combat C. difficile infections and antibiotic resistance under the National Strategy to Combat Antibiotic Resistant Bacteria.
An accompanying Morbidity and Mortality Weekly Report(www.cdc.gov) breaks down how the agency analyzed data from its National Healthcare Safety Network and Emerging Infections Program using two independently developed and complementary mathematical simulation models to reach its conclusions.
Among the CDC's projections:
- Coordinated approaches to interrupt the spread of HAIs could prevent up to 70 percent of life-threatening carbapenem-resistant Enterobacteriaceae (CRE) infections over a five-year span.
- During that same period, a partnership between federal agencies, health care facilities and health departments could prevent 619,000 HAIs caused by CRE, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA) or C. difficile and save 37,000 lives.
CDC Lays Out Battle Plan
Illnesses caused by C. difficile and drug-resistant bacteria such as CRE, MRSA and multidrug-resistant P. aeruginosa spread in and between health care facilities when appropriate infection control practices are not in place and patients transfer from one health care facility to another for care. But, the CDC noted, even facilities that follow recommended infection control and antibiotic use practices are at increased risk when they receive infected patients from other health care facilities.
The CDC's modeling offered specific examples of how various levels of coordination among 10 health care facilities that share patients could reduce CRE infections during a five-year period after first onset of the illness.
- The common approach (or status quo) resulted in 2,000 patients contracting CRE infections, impacting 12 percent of patients in the area.
- When a facility independently enhanced its infection control practices, 1,500 patients were infected with CRE, impacting 8 percent of patients.
- A coordinated effort among the facilities to prevent infections and notify each other of CRE-positive patients before their transfer resulted in 400 patients getting the infection, impacting only 2 percent of the patient population.
Overall, the agency recommended a coordinated, two-pronged approach to minimize transmission of HAIs:
- Health departments should track and alert health care facilities to outbreaks of illness caused by drug-resistant pathogens in their area and the threat of transmission from other facilities via patients transferring from one locale to another.
- Health care facilities should collaborate in working with public health authorities to implement shared infection control activities to stop the spread of antibiotic-resistant organisms and C. difficile between facilities.
CDC Vital Signs: A coordinated approach among health care facilities and public health departments is the best approach to fighting antibiotic-resistant infections.
Antibiotic Resistance Solutions Initiative Fires Up
During the next five years, the CDC will invest $264 million through its Antibiotic Resistance Solutions Initiative(www.cdc.gov) to combat C. difficile infections and antibiotic resistance as part of the National Strategy to Combat Antibiotic-Resistant Bacteria,(www.cdc.gov) and will collaborate with other federal partners to expand the nation's capabilities for antibiotic stewardship, outbreak surveillance and antibiotic-resistance prevention.
Proposed State Antibiotic Resistance Prevention Programs,(www.cdc.gov) known as "Protect Programs," would implement this coordinated approach. These programs would be funded through the president's fiscal year 2016 budget and would support work with health care facilities in all 50 states to detect and prevent both antibiotic-resistant germs and C. difficile infections. The FY 2016 budget also would fund efforts to improve antibiotic stewardship(www.cdc.gov) in health care facilities.
The CDC estimates these efforts hold the potential to cut the incidence of C. difficile, health care-associated CRE and MRSA bloodstream infections by at least half.
Here's How Family Physicians Can Help
To help combat antibiotic-resistant infections, the CDC recommends that prescribers, including family physicians, do the following:
- Prescribe antibiotics correctly by getting cultures and then promptly starting the right drug at the right dose for the right duration.
- Be aware of antibiotic-resistance patterns in your facility and area.
- Ask patients if they have recently received care in another facility.
- Follow hand hygiene and other infection-control measures with every patient.
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, echoed that advice, telling AAFP News that antibiotic resistance has been a continuing problem because previous efforts to address the issue have had limited effect.
"Although there are facilities that have accomplished significant change, inappropriate antibiotic use continues to be a widespread problem," she said. "Know the drug-resistance patterns in your community, prescribe antibiotics only when necessary, and practice hand hygiene before and after every patient encounter."
Frost added that the fight against antibiotic-resistant infections provides a great opportunity to further promote the integration of public health departments and primary care health professionals that the Academy addressed in its position paper "Integration of Primary Care and Public Health" last year and that the Practical Playbook(www.practicalplaybook.org) initiative has called for.
Related AAFP News Coverage
White House Spotlights Antibiotic Overuse in Medicine, Food Production
New Practices Aim to Slow Drug Resistance