Superbugs – The Growing Problem of Antibiotic Resistant Infections

On August 04, 2015, the Centers for Disease Control and Prevention or CDC released a report published in their monthly Vital Signs[1] newsletter regarding the increasing number of germs that no longer respond to the drugs designed to kill them. The report notes that inappropriate prescribing of antibiotics and lack of infection control actions can contribute to drug resistance and put patients at risk. Despite diligent precautions which may be implemented by one facility, these germs can be spread between health care facilities when patients are transferred from one to another.

The most common and deadliest of these superbug infections include carbapenem-resistant Enterobacteriacae or CRE which can cause deadly infections and have become resistant to nearly all antibiotics that we currently have in use. Perhaps the most commonly known antibiotic resistant infection methicillin resistant staphylococcus aureus or MRSA often causes pneumonia and sepsis. Also infections caused by Pseudomonas aeruginosa which can result in healthcare associated infection include strains that are resistant to almost all antibiotics. Clostridium difficile also known as ‘C. diff’ is a germ commonly found in health care facilities and is not resistant to antibiotics but results from antibiotic use killing the bodies “good germs” and allowing this bacterium to take over putting patients at high risk for deadly diarrhea.

In order to reduce the number of antibiotic resistant infections the CDC recommends beginning with implementation of systems to alert receiving facilities when transferring patients who have drug resistant germs as well as sharing data with the public health department about antibiotic resistance and other healthcare associated infections.

The CDC released these statistics in relation to the growing problems of antibiotic resistant infections:

• Antibiotic-resistant germs cause more than 2 million illnesses and at least 23,000 deaths each year in the US.
• Up to 70% fewer patients will get CRE over 5 years if facilities coordinate to protect patients.
• Preventing infections and improving antibiotic prescribing could avert 610,000 infections and save 37,000 lives from drug-resistant infections over 5 years. This would save the health care system nearly 8 billion dollars for treatment.

Source: CDC Vital Signs, August 2015

A study cited by the CDC where researchers think a more coordinated approach may be working included the South Dakota public health department which requires health care facilities to report cases of CRE for tracking the spread of the bacteria. Infections caused by the deadly bacteria in that sparsely populated state dropped from 24 to 4 over two years. In Illinois, the state health department maintains a registry of all patients infected with drug-resistant bacteria. When a hospital or nursing home admits a patient, the facility can check the registry to see if the patient has an infection and take the appropriate precautions to prevent transmission.

At this point, infection reporting is done voluntarily and many facilities do not comply. The Centers for Medicare and Medicaid Services (CMS) has begun fining hospitals with high rates of infections and other incidents of patient harm, but those punishments are based on only a few types of bacteria.

Recommendations by the CDC for healthcare facilities to combat the spread of these antibiotic resistant infections include implementation of systems to alert receiving facilities when transferring patients who have drug-resistant germs, reviewing and improving infection control measures within their facilities, sharing data with the public health department about antibiotic resistance and other healthcare associated infections, and making sure that their clinical staff has access to prompt and accurate laboratory testing for these germs.

The agency went further making recommendations to prescribers and healthcare staff to prescribe antibiotics correctly, getting cultures then starting the right drug promptly at the right dose for the right duration, and knowing when to stop antibiotic therapy. They also recommended being aware of antibiotic resistance patterns in each facility, asking patients if they have recently received care in another facility, and most importantly following hand hygiene and other infection control measures with every patient. Patients and their families should be educated on what they can do to protect themselves and their family against these ever increasing infections including informing health care workers if they have been hospitalized in another facility and insisting that everyone wash their hands before touching them as well as washing their own hands often.

Dr. John Jernigan, an official with the CDC and senior author of the paper stated, “Facilities can’t do it alone. There are not many places where a coordinated effort is happening and we think we need to do a much better job.”

[1] http://www.cdc.gov/vitalsigns/stop-spread/

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm64e0804a1.htm?s_cid=mm64e0804a1_w