Health officials and providers are scrambling to find ways to fight antibiotic-resistant infections, which affect 1 in 25 hospital patients and are responsible for 23,000 deaths each year.
The Centers for Disease Control and Prevention warns of a “tipping point” reached when an increasing number of germs no longer respond to the drugs created to combat them. The federal agency has been pushing providers to prescribe antibiotics responsibly, as well as improve care coordination to prevent infections like carbapenem-resistant Enterobacteriaceae (CRE) and Clostridium difficile from spreading between facilities, and to share best practices for managing the deadly infections.
Patients with weak immune systems and those at skilled nursing facilities and long-term acute care facilities are particularly vulnerable.
The CDC Thursday hosted a conference call in which clinical experts shared tips on preventing the spread of infection when patients are transferred from one healthcare facility to another. As one response, experts urge implementation of antimicrobial stewardship programs (ASPs), which are coordinated hospital efforts dedicated to improving antibiotic use.
Rush University Medical Center in Chicago is somewhat of a case study for ASPs after an incident in May 2008, when a patient presented at Rush with drug-resistant Klebsiella pneumoniae carbapenemase (KPC). The patient was traced to a long-term acute care hospital in Indiana, where 42 patients were additionally infected, said Dr. Robert Weinstein, a Rush University professor of medicine.
To combat the problem, long-term acute-care facilities and hospitals with more than 10 intensive-care-unit beds in Chicago's Cook County began point-prevalence culture surveys every six months, and launched KPC surveillance in 2010, Weinstein said. Between February 2010 and June 2013, there was a greater than 5% reduction rate in KPC cases, he said.
However, a real-time surveillance system to track CRE-infected patients was still needed. To that end, the Illinois Department of Public Health developed its extensively drug resistant organisms (XDRO) registry. Providers identify patients infected with CRE and enter their names into the registry, Weinstein said. Providers can then query the database for CRE-positive patients, he added.
Similar initiatives will be discussed and shared at the CDC's upcoming International Conference on Emerging Infectious Diseases in Atlanta. Scientists and public health professionals from around the world are expected to exchange research and ideas on emerging infectious-disease topics.
Participating agencies include the American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories and the World Health Organization.
The White House is keeping a close eye on the issue as well. Last year, President Barack Obama pledged $1.2 billion to improve antibiotic stewardship, surveillance, and reporting capabilities, and to spark innovation in the human health and agricultural sectors. Experts say adequate funding to implement scientific initiatives is one of the most important factors in preventing the continued emergence of drug-resistant antimicrobial diseases.
Earlier this month, the Food and Drug Administration issued additional guidance for hospitals on how to better sterilize duodenoscopes, which have been found to spread CRE if not properly cleaned.
