The recent appearance in the United States of an Escherichia coli strain that is resistant to the drug-of-last-resort colistin means hospitals should intensify efforts to prevent the spread of infectious bacteria, experts in the field say.
And if a hospital does not yet have a comprehensive anti-infection program, it must do what it takes to launch such an effort as soon as possible. "The emergence of an E. coli strain that is resistant to last-resort antibiotics means hospitals should be monitoring for bacteria with similar patterns of resistance," says John Lynch, M.D., medical director of infection control at Harborview Medical Center in Seattle. "If a hospital is not currently capable of this type of surveillance, it needs to start developing the ability to do so to prevent the spread of infectious bacteria."
Hospital infection control experts shouldn’t have to learn much that’s new, says Maria Ascano, an analyst with Decision Resources Group in Burlington, Mass. "Most of it is trying to intensify what's already there," Ascano says. "Unfortunately, this new strain of bacteria is a serious threat to hospitals and, more specifically, for hospitalized patients. The hospital environment provides a rich breeding ground for drug resistance given that antibiotics are so readily prescribed to inpatients."
Ascano says hospitals should respond to the new E. coli strain with these measures:
- Greater efforts to promote hand hygiene.
- Reduced use of colistin and carbapenems, another group of powerful antibiotics.
- Identification of patients with multidrug-resistant infections and isolate them.
- Stepped-up care and cleaning of indwelling catheters.
A 2014 report by the Centers for Disease Control and Prevention says various studies indicate that 30 to 50 percent of antibiotic use in hospitals is unnecessary or inappropriate, and that reducing unnecessary antibiotic use can decrease antibiotic resistance.
Lynch, speaking on behalf of the Infectious Diseases Society of America, says some but not all hospitals have initiated antimicrobial stewardship programs, which seek to optimize antibiotic use. "We're trying really hard to get stewardship programs in every single hospital."
Ascano says some hospitals, while instituting anti-infection programs, have not taken all the necessary steps to make the programs work as they should. "They say they have an antimicrobial stewardship program, but the reality is they don't have the measures, the tools in place that will actually help these programs be impactful."
It can be difficult for hospitals to do everything it takes to control drug-resistant infections, Ascano says. "When you reduce the use of carbapenems and colistin, you have to treat the patient with something, but the ideal alternatives are very expensive. So it takes budget managing, or an increase in the budget for antibiotics, to help these initiatives."
Lynch notes that "it takes resources. It costs money and people time. But we know from the data that antimicrobial stewardship programs save hospitals money and increase the quality of care and safety of patients."
In July 2014, the American Hospital Association and six national partners released a toolkit to help hospitals and health systems enhance their antimicrobial stewardship programs.
And in late May, the National Quality Forum released a playbook on antibiotic stewardship that was reported in a May 27 H&HN Daily article, "7 Practical Strategies for Installing an Antibiotic Stewardship Program."
Beyond steps that can be taken by hospitals, Lynch says there is a need for public health agencies to compile and report data on drug-resistant infections. "I can tell you how many cases of syphilis there are in the United States, how many cases of HIV there are in the United States. We don't have a program like that for drug-resistant bacteria, so we don't know what the rates are."