Who are the defenders against antimicrobial resistance?
Friday, November 17, 2017
Antibiotic resistance is one of the biggest threats to global health. Nearly 2 million Americans per year develop hospital-acquired infections (HAIs), resulting in 99,000 deaths — the majority of which are caused by bacteria that are resistant to multiple antibiotics.
Resistance to antibiotics can be attributed to the overuse and misuse of these medications. At least 30 percent of antibiotic courses prescribed in the outpatient setting are unnecessary. Most of this unnecessary use is for acute respiratory conditions, such as colds, bronchitis, sore throats caused by viruses, and even some sinus and ear infections.
New resistance mechanisms threaten the ability of physicians to treat common infectious diseases. And if nothing changes, and antimicrobial resistance isn't stopped, the World Health Organization predicts that people will die from minor injuries that become infected, much the same as decades ago.
Resident physicians are often the first to decide which antibiotics to start patients on to treat their illness or infection. In one study that assessed whether residents are prescribing in ways that best avoid antibiotic resistance, Dr. Geovanny F. Perez, M.D., a pulmonologist at Children's National Health System, and colleagues sent an email survey to all 189 residents at two large children's hospitals: Children's National in the greater Metropolitan Washington area and Nicklaus Children's Hospital in South Florida.
The survey was divided into two parts. The first part assessed the knowledge of these residents about which antibiotics are most appropriate to treat five common pediatric infections — acute otitis media, group A streptococcal pharyngitis, sinusitis, pneumonia and urinary tract infections. The second part ascertained how residents acquired their antibiotic knowledge and prescribing behaviors, importantly asking about their knowledge and awareness of antibiograms — profiles of medications effective against different local bacterial strains that are updated periodically at most hospitals.
Three-quarters of respondents indicated that they had prescribed antibiotics to patients they thought had a viral infection, rather than a bacterial one. About 63 percent answered that they were following instructions from an attending physician or senior resident, and 54 percent of residents said their general pediatric inpatient attending physician was their most influential source of knowledge in this area.
Another study suggests that communication breakdown between healthcare facilities contributes to outbreaks of infection. The OSU/OHSU College of Pharmacy teamed with the Oregon Health Authority and other collaborators on a two-year study of Acinetobacter baumannii, an opportunistic pathogen associated primarily with infections among patients who have compromised immune systems and are in healthcare facilities.
At multiple sites in the Pacific Northwest, the researchers identified 21 cases, including 16 isolates of A. baumannii that contained a rare gene responsible for resistance to the carbapenem class of antibiotics. The patients' transfer history and the isolates' genetic profiles illustrated how the organism spread from place to place, aided by a lack of communication between facilities about patients who were infected or colonized by A. baummanii.
Antimicrobial resistance is a crisis that can't be ignored. Although it is a complex problem, there are steps that can be taken by residents as well as by care facilities.
First, research suggests that antibiotic prescribers do five essential things correctly: Give the right patient the right medication at the right dose through the right route at the right time. Next, it's important that communication improves among healthcare facilities about patients' bacterial infections.
If this threat isn't addressed with strong, coordinated action, antimicrobial resistance will take us back to a time when people feared common infections and risked their lives from minor surgical procedures.
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