The community-wide dilemma of hospital-acquired drug resistance

Real, Leslie A.

doi:10.1073/pnas.0500088102

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…The use of Veterans Affairs data in the 10-facility model made it feasible to represent dependencies between lengths of stay, probabilities of readmission, and infection status. These are relationships that, in their basic form, likely are generalizable across health systems, and other models using different assumptions have suggested a similar advantage to regionally coordinated interventions involving other pathogens ( 4 , 5 ). Although the model assumptions incorporate active detection and isolation of CRE patients, the benefits illustrated in the model would be the same for any intervention (e.g., augmented hand hygiene efforts or skin antisepsis) that reduces transmission by the amount incorporated into the models.…”

Section: Conclusion and Commentmentioning

confidence: 88%

“…Although improvements within independent facilities are necessary, they might not be sufficient to reduce spread. These independent efforts do not account for the importance of inter-facility spread through movement of patients who are colonized or infected with these organisms, or the impact that one institution’s practices might have on the antibiotic resistance encountered by neighboring facilities ( 4 – 6 ). To date, even when fully implemented, this independent facility–based effort has not adequately controlled inter-facility spread of antibiotic-resistant pathogens ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States

Slayton¹,

Toth²,

Lee³

et al. 2015

MMWR Morb. Mortal. Wkly. Rep.

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Background: Treatments for health care-associated infections (HAIs) caused by antibiotic-resistant bacteria and Clostridium difficile are limited, and some patients have developed untreatable infections. Evidence-supported interventions are available, but coordinated approaches to interrupt the spread of HAIs could have a greater impact on reversing the increasing incidence of these infections than independent facility-based program efforts. Methods:Data from CDC's National Healthcare Safety Network and Emerging Infections Program were analyzed to project the number of health care-associated infections from antibiotic-resistant bacteria or C. difficile both with and without a large scale national intervention that would include interrupting transmission and improved antibiotic stewardship. As an example, the impact of reducing transmission of one antibiotic-resistant infection (carbapenem-resistant Enterobacteriaceae [CRE]) on cumulative prevalence and number of HAI transmission events within interconnected groups of health care facilities was modeled using two distinct approaches, a large scale and a smaller scale health care network. Results:Immediate nationwide infection control and antibiotic stewardship interventions, over 5 years, could avert an estimated 619,000 HAIs resulting from CRE, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. difficile. Compared with independent efforts, a coordinated response to prevent CRE spread across a group of inter-connected health care facilities resulted in a cumulative 74% reduction in acquisitions over 5 years in a 10-facility network model, and 55% reduction over 15 years in a 102-facility network model. Conclusions:With effective action now, more than half a million antibiotic-resistant health care-associated infections could be prevented over 5 years. Models representing both large and small groups of interconnected health care facilities illustrate that a coordinated approach to interrupting transmission is more effective than historical independent facilitybased efforts.Implications for Public Health: Public health-led coordinated prevention approaches have the potential to more completely address the emergence and dissemination of these antibiotic-resistant organisms and C. difficile than independent facility-based efforts.

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Section: Conclusion and Commentmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States

Slayton¹,

Toth²,

Lee³

et al. 2015

MMWR Morb. Mortal. Wkly. Rep.

View full text Add to dashboard Cite

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“…Rachel B. Slayton, PhD 1 ; Damon Toth, PhD 2 ; Bruce Y. Lee, MD 3 ; Windy Tanner, PhD 2 ; Sarah M. Bartsch, MPH 3 ; Karim Khader, PhD 2 ; Kim Wong, PhD 4 ; Kevin Brown, PhD 2 ; James A. McKinnell, MD 5 ; William Ray 2 ; Loren G. Miller, MD 6 ; Michael Rubin, MD, PhD 2 ; Diane S. Kim 7 ; Fred Adler, PhD 8 ; Chenghua Cao, MPH 7 ; Lacey Avery, MA 1 ; Nathan T.B. Stone, PhD 9 ; Alexander Kallen, MD 1 ; Matthew Samore, MD 2 ; Susan S. Huang, MD 7 ; Scott Fridkin, MD 1 ; John A. Jernigan, MD 1…”

Section: Vital Signs: Estimated Effects Of a Coordinated Approach Formentioning

confidence: 99%

Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States

Slayton

Toth

Lee

et al. 2015

MMWR Morb. Mortal. Wkly. Rep.

138

View full text Add to dashboard Cite

Background: Treatments for health care-associated infections (HAIs) caused by antibiotic-resistant bacteria and Clostridium difficile are limited, and some patients have developed untreatable infections. Evidence-supported interventions are available, but coordinated approaches to interrupt the spread of HAIs could have a greater impact on reversing the increasing incidence of these infections than independent facility-based program efforts. Methods: Data from CDC's National Healthcare Safety Network and Emerging Infections Program were analyzed to project the number of health care-associated infections from antibiotic-resistant bacteria or C. difficile both with and without a large scale national intervention that would include interrupting transmission and improved antibiotic stewardship. As an example, the impact of reducing transmission of one antibiotic-resistant infection (carbapenem-resistant Enterobacteriaceae [CRE]) on cumulative prevalence and number of HAI transmission events within interconnected groups of health care facilities was modeled using two distinct approaches, a large scale and a smaller scale health care network. Results: Immediate nationwide infection control and antibiotic stewardship interventions, over 5 years, could avert an estimated 619,000 HAIs resulting from CRE, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. difficile. Compared with independent efforts, a coordinated response to prevent CRE spread across a group of interconnected health care facilities resulted in a cumulative 74% reduction in acquisitions over 5 years in a 10-facility network model, and 55% reduction over 15 years in a 102-facility network model. Conclusions: With effective action now, more than half a million antibiotic-resistant health care-associated infections could be prevented over 5 years. Models representing both large and small groups of interconnected health care facilities illustrate that a coordinated approach to interrupting transmission is more effective than historical independent facilitybased efforts. Implications for Public Health: Public health-led coordinated prevention approaches have the potential to more completely address the emergence and dissemination of these antibiotic-resistant organisms and C. difficile than independent facility-based efforts. * Methicillin-resistant Staphlococcus aureus, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Pseudomonas aeruginosa.

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“…Experience with other multidrug-resistant organisms (MDROs) suggests that an early, aggressive approach to control the organism when newly emerging is more effective and efficient in controlling transmission than responding when more widespread [21,22]. This review summarizes the current recommended approach to managing cases of C. auris and control transmission of C. auris in healthcare facilities.…”

Section: Introductionmentioning

confidence: 99%

Approach to the Investigation and Management of Patients With Candida auris, an Emerging Multidrug-Resistant Yeast

Tsay

Kallen

Jackson

et al. 2017

Clinical Infectious Diseases

129

127

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Candida auris is an emerging, multidrug-resistant yeast that can spread in healthcare settings. It can cause invasive infections with high mortality and is difficult to identify using traditional yeast identification methods. C. auris has been reported in over a dozen countries, and as of July 2017, 99 clinical cases have been reported in the United States;. C. auris can colonize skin and persist in the healthcare environment, allowing for transmission between patients. Prompt investigation and aggressive interventions, including notification of public health agencies, implementation of contact precautions, thorough environmental cleaning and disinfection, infection control assessments, contact tracing and screening contacts to assess for colonization, and retrospective review of microbiology records and prospective surveillance for cases at laboratories are all needed to limit the spread of C. auris. This review summarizes the current recommended approach to manage cases of C. auris and control transmission of C. auris in healthcare facilities.

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The community-wide dilemma of hospital-acquired drug resistance

Cited by 7 publications

References 18 publications

Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States

Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States

Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States

Approach to the Investigation and Management of Patients With Candida auris, an Emerging Multidrug-Resistant Yeast

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