Antibiotic resistance: Putting the ‘care’ in healthcare

In theory one goes to the hospital to get better, not to get sicker. Nevertheless, the fact remains that inpatients can become infected with serious healthcare-associated infections (HAIs) caused by antibiotic-resistant bacteria. The main offenders are:

·         C. difficile.

·         Carbapenem-resistant Enterobacteriaceae (CRE).

·         Methicillin-resistant Staphylococcus aureus (MRSA).

·         ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases).

·         Vancomycin-resistant Enterococcus (VRE).

·         Multidrug-resistant Pseudomonas aeruginosa.

·         Multidrug-resistant Acinetobacter.

“New data show that far too many patients are getting infected with dangerous, drug-resistant bacteria in healthcare settings,” CDC director Dr. Tom Frieden said in a press releases à propos of the agency’s latest Vital Signs report. “Doctors and healthcare facilities have the power to protect patients – no one should get sick while trying to get well.” HAIs are commonly reported after surgery or after the placement of a catheter, and they can lead to sepsis and death. According to the CDC’s annual progress report, in national acute care hospitals:

·         9 in 10 diagnoses of C. difficile are related to healthcare.

·         1 in 7 surgical site infection (SSIs) were caused by urgent or serious antibiotic-resistant threats.

·         1 in 10 catheter-associated urinary tract infections (CAUTIs) were caused by urgent or serious antibiotic-resistant threats.

·         1 in 6 central line-associated bloodstream infections (CLABSIs) were caused by urgent or serious antibiotic-resistant threats.

Preventing infections from catheters and following surgery, preventing the spread of bacteria, and improving antibiotic use are quintessential measures to reduce HAIs.

Preventing healthcare antibiotic-resistant infections

Preventing infections from catheters and following surgery

·         Using catheters only when necessary.

·         Following recommendations for safer surgery and catheter insertion and care.

·         Removing catheters from the patient as soon as they are no longer required.

Preventing the spread of bacteria

·         Improving hand hygiene.

·         Wearing gloves, gowns, and dedicated equipment for patients with resistant bacteria.

·         Knowing about antibiotic-resistant HAI outbreaks in your hospital and region.

Improving antibiotic use

·         Getting cultures and starting antibiotics promptly, especially in the case of sepsis.

·         Using cultures to re-evaluate the need for antibiotics and stop antibiotic treatment as soon as no longer necessary.

·         When needed, using appropriate antibiotics in the proper dosage, frequency, and duration.


It’s not all bad news, though. “The good news is that we are preventing healthcare acquired infections, which has saved thousands of lives,” Deputy Administrator and Chief Medical Officer at Centers for Medicare and Medicaid Services Patrick Conway, M.D., M.Sc. said. “The challenge ahead is how we help to prevent antibiotic resistance as well as infections. We are using incentives, changes in care delivery, and transparency to improve safety and quality for patients.” According to the CDC’s annual progress report, acute care hospitals have achieved:

·         A 50% decrease in CLABSIs) during 2008-2014.

·         A 17% decrease in SSIs during 2008-2014 related to 10 procedures tracked in previous HAI progress reports.

·         No change in the overall CAUTIs during 2009-2014, but there was progress in non-ICU settings, progress in all settings during 2013-2014, and more progress in all settings towards the end of 2014.

At the same, there’s plenty of room for improvement.

What to do

Federal government

·         Conducts surveillance for HAIs and antibiotic resistance, using data to target prevention, and promoting implementation of recommendations.

·         Identifies emerging resistant threats.

·         Responds to and controls outbreaks.

·         Promotes appropriate use and provides guidance/assesses implementation of stewardship programs across healthcare settings.

·         Prevents HAIs and improves antibiotic use to better patient protection.

·         Collaborates with partners to implement prevention and stewardship strategies, including in federal facilities. 

Healthcare providers

·         Follow recommendations to prevent C. difficile and infections that can occur following surgery or related to single-use catheters placement.

·         Follow recommended actions with every patient every time.

·         Isolate patients when appropriate, and know antibiotic resistance patterns in their facility/area.

·         Prescribe antibiotics correctly.

·         Get cultures, start antibiotics promptly, and re-evaluate 24 to 48 hours later.

·         Recognize when to stop antibiotic treatment.

Healthcare facility CEOs/administrators

·         Follow CDC guidelines to prevent infections and promote data use to target prevention and improvements.

·         Ensure staff follows hand hygiene, isolation, and environmental/device cleaning practices.

·         Establish stewardship program and enroll hospitals to submit data to CDC’s Antimicrobial Use and Resistance (AUR) Module.

·         Prioritize infection prevention, sepsis prevention, and stewardship.

·         Participate in a Quality Innovation Network.

State and local health departments

·         Establish goals, monitor the state’s progress in preventing infections, promote action, and achieve regional prevention.

·         Support institutions to meet these goals.

·         Support stewardship efforts and know antibiotic resistance patterns in the area. 

Patients and their families

·         Ask if a catheter is necessary.

·         Ask doctors how they prevent surgery-related infections.

·         Insist that everyone clean their hands before touching the patient.

·         Clean your hands often.

·         Explore Hospital Compare tool for HAI data.

·         Ask if antibiotics are necessary and what measures are being taken to improve antibiotic use and protect patients.


 “For clinicians, prevention means isolating patients when necessary,” Associate Director for Science at CDC’s Division of Healthcare Quality Promotion Dr. Clifford McDonald said. “It also means being aware of antibiotic resistance patterns in your facilities, following recommendations for preventing infections that can occur after surgery or from central lines and catheters placed in the body, and prescribing antibiotics correctly.”

Related: Doctors, get smart and learn about when antibiotics work