Coordinated Approach Could Decrease Infections and Deaths From Antibiotic Resistant Bacteria Interview with:
Rachel Slayton PhD
National Center for Emerging and Zoonotic Infectious Diseases

Medical Research: What is the background for this study? What are the main findings?

Dr. Slayton: Antibiotic-resistant bacteria cause more than 2 million illnesses and at least 23,000 deaths each year in the US. Additionally, Clostridium difficile caused close to half a million illnesses in 2011, and an estimated 15,000 deaths a year are attributable to C. difficile infections. Antibiotic resistance is a regional problem with inter-facility spread through movement of patients who are colonized or infected with these organisms.

In our first analysis we projected the national incidence of infections and deaths from Carbapenem-resistant Enterobacteriaceae (CRE), Clostridium difficile, invasive methicillin-resistant Staphylococcus aureus (MRSA), and multidrug-resistant Pseudomonas aeruginosa. With immediate implementation of national interventions combining infection control and antibiotic stewardship and, assuming similar effectiveness to that reported in other countries, an estimated 619,000 health care–associated infections and 37,000 deaths could be averted over 5 years.

Using CRE as an exemplar, we also estimated the effect of a coordinated approach in a network for the preventing the spread of antibiotic-resistance organisms among healthcare facilities that share patients. Our Carbapenem-resistant Enterobacteriaceae modeling was done in collaboration with Johns Hopkins Bloomberg School of Public Health, the University of Utah, and University of California Irvine School of Medicine. Both models clearly show that we could see fewer antibiotic-resistant infections if health care facilities and public health officials work together as a team. For example, five years after Carbapenem-resistant Enterobacteriaceae enters an area with 10 facilities that share patients, baseline activity alone resulted a prevalence of healthcare-associated CRE infection or colonization of 12.2% with 2,141 patients acquiring CRE. With independent facility-augmented efforts, we estimated that there would be an 8.6% prevalence with 1,590 patients acquiring Carbapenem-resistant Enterobacteriaceae. With a coordinated augmented approach, we estimated that there would be a 2.1% prevalence with 406 patients acquiring CRE. Using a 102-facility model of Orange County, California, we estimated that over 15 years countywide 19,271 patient acquisitions could be prevented with the coordinated augmented approach compared with independent-facility efforts.

Medical Research: What should clinicians and patients take away from your report?

Dr. Slayton:  Clinicians should be aware of antibiotic resistance patterns in their facility and area to protect their patients. They should prescribe antibiotics correctly, ordering cultures then starting the right drug promptly at the right dose for the right duration. Clinicians should ask patients if they have recently received care in another facility. Finally, clinicians should follow hand hygiene and other infection control measures with every patient.

Patients and their families can ask their healthcare providers what they and the facility are doing to protect you from an antibiotic-resistant or C. difficile infection. Additionally, patients can tell their doctors if they have recently been in another healthcare facility, including hospitals and nursing homes. Importantly, patients should insist that every healthcare provider wash their hands before touching you.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Slayton: For some of the questions we ask, like the ones we address in this study, we cannot get the answers we need through traditional epidemiologic study techniques.  To do so is often impossible or not feasible- would take many years, have enormous expense, even if attempted would likely have so many complexities and weaknesses that the results may be impossible interpret. In such cases, we have choices–we can take no action, we can take action based on opinions or guesses, or we can use modeling as a tool to generate additional information that is valuable in guiding our actions. Continuing to use mathematical modeling as a complementary tool to traditional epidemiologic studies will enhance future research studies and public health decision making.


MMWR: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States

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