Essentially , bacteria become resistant to antibiotics , and when this happens , antibiotics fail , and the bacteria multiply . The resistant bacteria will stick around , as there is now less competition and they can proliferate , increasing the risk for the development of antibiotic-resistant infections .”
— DJ Shannon , MPH , CIC , VA-BC , FAPIC
for NHSN reporting and then get that information to our antibiotic stewardship committee .” Shannon continued , “ It ’ s important to get that data to our internal stakeholders , such as prescribers , pharmacists , nurses , and hospital leaders , not just our external stakeholders . And then regarding education , it ’ s important to educate prescribers , pharmacists , and nurses about adverse reactions from antibiotics , as well as about antibiotic resistance and optimal prescribing . Bear in mind that care providers don ’ t always know what they ’ re looking at when they ’ re seeing susceptibility results , so we must be able to help our providers , our bedside staff , understand the data they are looking at and recognize the importance of something as simple as isolation for our patients with resistant pathogens .”
Shannon addressed stewardship efforts for IPs who may be working in a limited-resource setting such as a critical-access hospital . “ Start small , don ’ t try to take on the whole world of antimicrobial resistance and do all seven core elements ,” he advised . “ Start with a committee , a small working group , and then focus on a single priority for the year , such as getting AU data validated for NHSN surveillance . Taking on more than that can be very daunting , even for a facility that has a lot of resources . Take it one bit at a time .”
He also reviewed opportunities to impact antimicrobial resistance , such as implementing contact precautions and environmental cleaning and disinfection , engaging in hand hygiene , colonization screening , surveillance , antibiotic and device stewardship , as well as interfacility communication . More complex strategies to address AMR include diagnostic stewardship , vaccination , antibody therapy , phage therapy , fecal microbiota transplant , drug development , and a One Health approach .
As part of his presentation , Shannon covered the basics of AMR , reminding APIC attendees that antibiotic resistance occurs when bacteria no longer respond to the drugs designed to kill them , and that any time antibiotics are used , they can cause antibiotic resistance .
“ We have more than 2.8 million infections each year and about 36,000 deaths in the U . S . alone , and we know this information to be underreported because we do not have national-level antibiotic resistance and pathogen surveillance ,” Shannon said , addressing AMR prevalence . “ So , we know this is just a rough estimate and there is quite a burden in hospitals as well as in the community .”
Essentially , bacteria become resistant to antibiotics , and when this happens , Shannon explained , antibiotics fail , and the bacteria multiply . “ The resistant bacteria will stick around , as there is now less competition and they can proliferate , increasing the risk for the development of antibiotic-resistant infections .”
Shannon pointed to several societal constructs that impact antimicrobial resistance . The first , he explained , is the One Health approach . “ It ’ s where different partners , whether we ’ re talking healthcare , agriculture or veterinary science , they all are a part of the puzzle that is contributing to the development of antibiotic resistance . We can ’ t address the problem in totality unless we all work together in a One Health concept , meaning bringing the different sectors together to address antibiotic resistance . Importantly , within healthcare , we have active antibiotic stewardship teams and programs through which we attempt to de-escalate antimicrobial use . We want to make sure that our physicians or our advanced practice nurses are prescribing appropriately .”
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Six Antimicrobial-Resistant Hospital-Onset Infections Increased During the COVID-19 Pandemic
The Centers for Disease Control and Prevention
( CDC ) has used new data to update the burden of seven antimicrobial-resistant pathogens typically found in healthcare settings in the U . S .
In July 2024 , CDC published a fact sheet using new data to update the U . S . burden of the following seven antimicrobial-resistant pathogens typically found in healthcare settings : Carbapenem-resistant Enterobacterales ( CRE ), Carbapenem-resistant Acinetobacter , Candida auris ( C . auris ), methicillin-resistant Staphylococcus aureus ( MRSA ), vancomycin-resistant Enterococcus ( VRE ), extended-spectrum beta-lactamase ( ESBL ) -producing Enterobacterales , and multidrug-resistant ( MDR ) Pseudomonas aeruginosa .
The CDC previously reported that the burden of these pathogens increased in the U . S . in 2020 in the COVID-19 Impact Report . The new data describe the burden in the two following years , 2021 and 2022 , and compare against 2019 data .
The new data show that six bacterial antimicrobial-resistant hospital-onset infections increased by a combined 20 percent during the COVID-19 pandemic compared to the pre-pandemic period , peaking in 2021 , and remaining above pre-pandemic levels in 2022 . In 2022 , rates for all but one of these pathogens ( MRSA ) remained above pre-pandemic levels . In addition , the number of reported clinical cases of C . auris — a type of yeast that can spread in healthcare facilities , is often resistant to antifungal medications , and can cause severe illness — increased nearly five-fold from 2019 to 2022 .
The increases in antimicrobial resistance ( AR ) burden seen in 2020 and 2021 are likely due in part , according to the CDC , to the impact of COVID-19 , which pushed healthcare facilities , health departments and communities near their breaking points . This resulted in longer hospital stays for hospitalized patients ( including those diagnosed with COVID-19 ), challenged the implementation of infection prevention and control practices and increased inappropriate antibiotic use .
As the pandemic continued , healthcare providers and public health professionals took aggressive action to prevent infections and protect lives , helping to reduce the burden of AR from its 2021 peak . CDC supported many of these efforts through American Rescue Plan Act ( ARP ) funding to health-department Healthcare-Associated Infections and Antimicrobial Resistance ( HAI / AR ) Programs and CDC ’ s Antimicrobial Resistance Laboratory Network ( AR Lab Network ) in all U . S . states , as well as some large cities and territories .
In the first year of work supported by ARP
10 • www . healthcarehygienemagazine . com • august 2024