This article appears in the January/February print issue of Surgical Products.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that each year more than 2 million hospitalized patients contract a Healthcare Associated Infection (HAI), resulting in approximately 100,000 deaths. In September 2013, the CDC released new evidence of emergent antimicrobial resistance threats and categorized them into categories of urgency. According to the new report, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.

It is standard practice for many surgical procedures to administer antibiotic prophylaxis to reduce the risk of a surgical site infection. However, with this routine practice comes potential risk for antimicrobial resistance. Hospitals are notorious over-users of antibiotics, many of which are unnecessary, such as those used to “treat” viral infections or blood culture contaminants.

The CDC has identified three bacteria that have reached critical threat level: Clostridium difficile (C. difficile), Carbapenem-resistant Enterobacteriaceae (CRE), and Drug-resistant Neisseria gonorrhoeae. Several other multi-drug resistant organisms such as MRSA were also identified as serious threats to society. In addition, almost 250,000 people each year require hospital care for Clostridium difficile infections.

In most of these infections, the use of antibiotics was a major contributing factor leading to the illness. At least 14,000 people die each year in the United States from C. difficile infections. Many of these infections could have been prevented.

Antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. healthcare system. In most cases, antibiotic-resistant infections require prolonged and/or costlier treatments, extend hospital stays, necessitate additional doctor visits and healthcare use, and result in greater disability and death compared with infections that are easily treatable with antibiotics. The total cost of antibiotic resistance to the U.S. economy has been difficult to calculate to date.

Estimates vary, but have gone as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year.

The use of antibiotics is the single most important factor leading to antibiotic resistance around the world. Antibiotics are among the most commonly prescribed drugs used in human medicine. However, up to 50% of all the antibiotics prescribed for people are not needed or are not optimally effective as prescribed. Antibiotics are also commonly used in food animals to prevent, control, and treat disease, and to promote the growth of food-producing animals.

The use of antibiotics for promoting growth is not necessary, and the practice should be phased out. Because of the overlap of the use of antibiotics in both medical and consumer settings, hospitals must be even more judicious with the use of these powerful pharmaceuticals. Many facilities establish a restrictive protocol of available antibiotics that is closely based on the facility’s antibiogram. This practice effectively limits the inappropriate use of drugs known to cause resistance at the specific institution.

The other major factor in the growth of antibiotic resistance is the spread of resistant strains of bacteria from person to person, or from the non-human sources in the environment, including food.
There are four core actions that the CDC has identified to fight these deadly infections: 

  • Preventing infections and preventing the spread of resistance.
  • Tracking resistant bacteria through the electronic medical record and also the duration of the patient’s stay.
  • Improving the use of today’s antibiotics, including a comprehensive antimicrobial stewardship campaign that is hard-wired into the culture of the hospital.
  • Promoting the development of new antibiotics and developing new diagnostic tests for resistant bacteria. In addition, hospitals must also implement rapid identification technologies for quickly identifying these high risk microorganisms, and then placing the affected patients into the appropriate type of isolation.

Bacteria will inevitably find ways of resisting the antibiotics that are developed, which is why aggressive action is needed now to keep new resistance from developing and to prevent the resistance that already exists from spreading. Hospitals should collaborate with the facility’s clinical pharmacy department, infection preventionists, and pharmacy and therapeutics committee to closely monitor trends and take action as necessary to reduce the risk for resistance.

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