HealthDay News – Patients treated in U.S hospitals are still being infected with strains of antibiotic-resistant bacteria, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC).1

In hospitals, one in seven infections from catheters or surgery were caused by antibiotic-resistant bacterial strains. In long-term acute care hospitals, where patients generally stay 25 days or more, the rate of these infections rises to one in four, according to the new report. 

The six common antibiotic-resistant bacteria are: carbapenem-resistant Enterobacteriaceae; methicillin-resistant Staphylococcus aureus; ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases); vancomycin-resistant Enterococcus; multidrug-resistant Pseudomonas aeruginosa; and multidrug-resistant Acinetobacter.


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Some of the report’s major findings on acute care hospitals included a 50% reduction seen in infections from catheters placed in large veins between 2008 and 2014; one in six of these remaining infections were caused by antibiotic-resistant bacteria. 

A 17% reduction in surgical-site infections was seen between 2008 and 2014; one in seven of these remaining infections were caused by antibiotic-resistant bacteria. No change in overall infections from urinary catheters was seen between 2009 and 2014. But some progress was made by the end of 2014. Still, one in 10 of these infections were caused by antibiotic-resistant bacteria.

To combat the problem of antibiotic-resistant infections, the CDC is calling on physicians, nurses, and hospital staff to continue to prevent the spread of bacteria between patients. The CDC is also asking health care professionals to reduce infections related to surgery and placement of catheters. The agency is also calling for cautious use of antibiotics to help fight resistance.


Summary and Clinical Applicability

Infection control programs aim to prevent and reduce rates of healthcare-associated infections (HAI). Major components of infection control include standard universal precautions, isolation precautions, and routine hospital infection surveillance. Standard precautions are generally recommended in the care of all hospitalized patients as they have been associated with a reduced the risk of infection transmission between patients and healthcare workers.2

All types of intravascular catheters are associated with an increased risk of localized infection, as well as catheter-related bloodstream infection.3 The catheter placement site changes infection risk.3  For peripheral venous catheters, the risk is higher in the lower extremity as compared with the upper extremity, and the risk is higher in the wrist or upper arm compared with the hand.3 

For central venous catheters (CVC), infection rates for femoral catheters are generally higher than other access sites.3  The risk of catheter infection increases with the duration of catheter placement.3  Routine evaluation of the necessity of these catheters must be done, to minimize the duration of time an indwelling catheter remains in place. If the catheter is deemed necessary, daily examination of the catheter site and aseptic technique in catheter care is crucial.  However, a pre-defined time period to routinely swap out CVCs or peripheral arterial catheters has not been established, especially in patients where peripheral access is challenging. 

Catheter-associated urinary tract infections (UTIs) are also common nosocomial infections, with the duration of catheterization being an important risk factor for infection. Avoidance of unnecessary urinary catheterization, use of sterile technique during insertion, and evaluation for necessity and removal are essential to the prevention of catheter-associated UTI.4 

HAI surveillance is an integral portion of infection control programs in hospitals. The collection of accurate surveillance data allows practitioners to identify possibly resistant pathogens and to detect outbreaks early in their course.

Summary and Clinical Applicability Statement by Corinna Panlilio Sison MD

Reference

1. Centers for Disease Control and Prevention. Making Health Care Safer Protect patients from antibiotic resistance.Available at: http://www.cdc.gov/vitalsigns/protect-patients/index.html. Accessed March 4, 2016.

2. Ellingson K, Haas JP, Aiello AE, et al. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol 2014; 35:937.

3. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011; 52:e162.

4. Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010; 50:625.