creating universally applied guidelines .”
Infectious threats – from H1N1 to SARs-CoV-2 and every pathogen in between – can exacerbate the control of antibiotic-resistant organisms that the CDC has categorized as the biggest threats and impact antimicrobial stewardship efforts . In an era of last-resort antibiotics , Morris notes , “ I think the biggest challenges these have posed have been a ) they are a huge distraction ( so people don ’ t have antimicrobial stewardship and AMR top-of-mind ), and b ) they can confuse clinicians and / or increase clinician clinical anxiety , for which they will often prescribe antibiotics . Additionally , with COVID-19 , we have seen a massive shift to virtual care , and this has often resulted in unnecessary antibiotic prescribing , primarily because of uncertainty .”
While one could expect that the pandemic ’ s greater emphasis on hygiene efforts may have shifted infection control behavior among both the public and healthcare providers , Morris says there are factors that could hamper AMR-prevention efforts .
“ Overall , one would think that this would help the AMR effort overall , with reduced communal spread of all microorganisms ; however , it has resulted in more dental problems treated with antibiotics , and more overall ‘ defensive prescribing ’ and ‘ diagnostic uncertainty ’ all around – at least in some healthcare centers , this is resulting in increased prescribing .” Device-Related Infections and AMR In November 2019 , a report from the Centers for Disease Control and Prevention ( CDC )’ s National Healthcare Safety Network ( NHSN ) reported that healthcare-associated infections ( HAIs ) related to the use of medical devices are more likely to be antibiotic-resistant than HAIs that result from surgical procedures .
“ Combating antimicrobial resistance is a top clinical and public health priority in the United States ,” said Lindsey Weiner-Lastinger , MPH , an epidemiologist at the CDC . “ These data show that the threat of exposure to bacteria that are resistant to antibiotics extends across the nation . The data also serve as an urgent call for healthcare facilities and public health agencies to intensify their efforts to prevent the emergence and spread of antimicrobial resistance .”
The report , which summarizes data from 5,626 facilities from 2015 to 2017 , shows that resistance was consistently higher for device-associated HAIs than for the same bacteria identified after surgical procedures . Devices studied were not permanent implants but rather devices used for limited time in a hospital setting such as central lines , ventilators , and urinary catheters . For instance , 48 percent of tested Staphylococcus aureus isolated from device-associated infections were methicillin resistant ( MRSA ), compared to 41 percent among those isolated from surgical site infections ; and 82 percent of tested device-associated Enterococcus faecium bacteria were resistant to vancomycin ( VRE ) compared to 55 percent among surgical site infections .
Researchers noted that microorganisms in adult and pediatric facilities varied by infection type and care location . The most common HAI bacteria among adult patients were Escherichia coli ( 18 percent ), Staphylococcus aureus ( 12 percent ) and Klebsiella ( 9 percent ). A companion report on pediatric healthcare-associated infections , with data from 2,454 facilities , found the most prevalent pathogens among pediatric patients were Staphylococcus aureus ( 15 percent ), Escherichia coli ( 12 percent ), and coagulase-negative staphylococci ( 12 percent ).
The data also showed that bacteria associated with long-term acute -care hospitals are more likely to be antibiotic resistant than those acquired in short-stay acute-care hospitals ; and HAIs in adult healthcare settings are more likely to be resistant than those in pediatrics .
Weiner-Lastinger said the increasing availability of clinical and laboratory data in electronic form provides new opportunities to quickly identify resistance to antibiotic therapies and to inform antibiotic stewardship programs . Appropriate resources should be allocated to ensure proper infection prevention methods of devices and the environment across the healthcare continuum . Infection Prevention and Control Gaps and AMR Infection prevention and control research priorities have no doubt been impacted by emerging infectious threats , and in their review and survey analysis , Lacotte , et al . ( 2020 ) outlined what can be done to combat both healthcare-associated infections and antimicrobial resistance . They emphasize that while infection prevention and control ( IP & C ) is one of the most cost-effective interventions against antimicrobial resistance ( AMR ), IP & C knowledge gaps often receive little prominence in AMR research agendas .
From their scrutiny of the medical literature , the researchers identified several priorities , including the assessment of organizational , socio-economic , and behavioral barriers / facilitators for the implementation of IP & C programs ; the impact of overcrowding on the spread of infections ; and the impact of infrastructural changes at facility level on the reduction of infections .
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