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Antimicrobial Resistance

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Antimicrobial drugs have been used since the 1940s to treat diseases and perform surgery, chemotherapy, and organ transplants. These drugs have saved millions of lives worldwide. However, over time and due to the growing use of these drugs in humans and on the farm, many bacteria, fungi, viruses, and parasites have changed in ways that make the drugs less effective.  Some organisms become resistant to a single antimicrobial drug (or related class of drug), while others become resistant to many antimicrobial drugs or classes. These organisms are often called multi-drug-resistant organisms (MDRO). In some cases, the organisms have become so resistant that no available antibiotics can fight against them.

Infections with drug-resistant organisms are mainly a problem in hospitals and other health care settings, but they can also spread in the community.  People infected with drug-resistant organisms are more likely to have longer and more costly hospital stays, and may be more likely to die from the infection. When the drug of choice for treating an infection does not work, they require treatment with drugs that may be less effective, more toxic, and more expensive. This means that patients with an antimicrobial-resistant infection may suffer more and pay more for treatment.

  • FAQ for Patients and Families
  • Prevention Strategies for Health Care Professionals
  • Antibiotic Stewardship Webinars
  • Resources

What is antimicrobial resistance?

Antimicrobial resistance is a big problem in the United States. Each year at least two million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die because of these infections. Many more people die from other conditions that were complicated by an antibiotic-resistant infection. Antimicrobial resistance is the natural ability of a microbe to change and become unaffected by drugs, meaning that they are not killed and the infection remains. Infections with drug-resistant organisms are hard to treat and require costly and sometimes toxic alternatives. No one can fully avoid the risk of antibiotic-resistant infections, but there are steps you can take to reduce your chance of getting infected.

What is a microbe?

Microbes are organisms that cannot be seen by the eye and are found everywhere on Earth. The different types of microbes are bacteria, viruses, fungi, and parasites. Most microbes are harmless and can even be helpful to humans, but some can cause disease. Disease-causing microbes are called pathogens. All types of microbes can develop resistance to antimicrobials, becoming drug-resistant organisms.

What is an antimicrobial?

An antimicrobial is a type of drug that kills or stops the growth of bacteria, viruses, fungi, and parasites.

What is an antibiotic?

An antibiotic is a type of drug that kills or stops the growth of bacteria. Examples include penicillin and ciprofloxacin. Common bacterial infections include strep throat, whooping cough, and urinary tract infection. Viral infections, such as the common cold or the flu, should not be treated with antibiotics.

How does antimicrobial resistance occur?

Simply using antibiotics creates resistance. Antibiotics are among the most commonly prescribed drugs in human medicine. However, up to 50% of these prescriptions are given when not needed, with the wrong dose, or for the incorrect period of time.

What can I do to prevent antimicrobial resistance?

  • Ask your doctor if tests will be done to make sure the right antibiotic is prescribed.
  • Take antibiotics exactly as your doctor prescribes. Do not skip doses and complete the prescribed course of treatment, even when you start feeling better.
  • Only take antibiotics prescribed for you – do not share or use leftover antibiotics.
  • Discard any leftover medication once the prescribed course of treatment is completed.
  • Do not ask for antibiotics when your doctor thinks you do not need them. Remember antibiotics have side effects.
  • Prevent infections by practicing good hand hygiene and getting recommended vaccines.

 

Can antibiotics be used to treat colds or the flu?

Antibiotics will not work on viruses, such as colds and flu, or runny noses, even if the mucus is thick, yellow, or green. Respiratory infections usually go away in a week or two without treatment. Using an antibiotic will not help you and you could be harmed by side effects caused by the drug.

  • Do not request antibiotics when your doctor thinks you do not need them.
  • Ask your doctor or nurse about the best way to feel better – pain relievers, fever reducers, saline nasal spray or drops, warm compresses, drinking liquids, and rest may help.
  • Keep others healthy by cleaning hands, covering coughs, and staying home when sick.
  • To prevent these infections, get recommended vaccines.
  • Antiviral treatment is available for the flu. Please visit the influenza page for more information.

Antimicrobial resistance is a growing problem in the United States and a significant threat to public health in the health care setting. Each year at least two million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die because of these infections. Many more people die from other conditions that were complicated by an antibiotic-resistant infection. Antimicrobial resistance is the natural ability of a microbe to change and become unaffected by drugs, meaning that they are not killed and the infection remains. Infections with drug-resistant organisms are difficult to treat and require costly and sometimes toxic alternatives. Antibiotic-resistant infections can occur anywhere. However, most deaths related to antibiotic resistance happen in inpatient health care settings, such as hospitals and nursing homes. 

 

Strategies for Preventing Antimicrobial Resistance for Inpatient and Long-Term Care Health Care Providers

  • Prescribe antibiotics correctly – get cultures, start the right drug promptly at the right dose for the right duration.
  • Document the dose, duration and indication for every antibiotic prescription.
  • Review antibiotic therapy 48 to 72 hours after it is started based on the patient’s/resident’s clinical condition and microbiology culture results, and stop or change antibiotic orders as needed.
  • Stay aware of antibiotic resistance patterns in your facility.
  • Participate in and lead efforts within your hospital to improve prescribing practices.
  • Follow hand hygiene and other infection control measures with every patient.
  • Request immediate alerts when a drug-resistant infection in your patients is identified by the lab.
  • Alert the receiving facility when a patient with a drug-resistant infection is transferred.
  • Follow relevant guidelines and precautions at every patient encounter, including proper hand hygiene, appropriate personal protective equipment, and environmental cleaning.
  • Remove temporary medical devices, such as catheters and ventilators, as soon as they are no longer needed.
  • Talk to patients/residents and families about when antibiotics are and are not needed, and discuss possible harms such as allergic reactions, C. difficile, and antibiotic-resistant infections.

 

Strategies for Preventing Antimicrobial Resistance for Outpatient Health Care Providers

  • Follow clinical guidelines when prescribing antibiotics, and prescribe the right antibiotic, at the right dose, for the right duration, and at the right time.
  • Only prescribe antibiotics when they are needed. Help patients understand why an antibiotic is not needed for a viral infection, what to do to feel better, and when to seek care again if symptoms do not resolve.
  • Talk to your patients and their families about possible harm from antibiotics, such as allergic reactions, C. difficile infection, and antibiotic-resistant infections.
  • Watch for signs of sepsis; if you suspect sepsis, start antibiotics immediately. Signs include confusion or disorientation, shortness of breath, high heart rate, fever, shivering or feeling very cold, extreme pain or discomfort, and clammy or sweaty skin.
  • Follow hand hygiene and other infection prevention measures with every patient.

 

Strategies for Preventing Antimicrobial Resistance for Health Care CEOs, Medical Officers, and Other Health Care Facility Leaders

  • Adopt an antibiotic stewardship program that includes the seven Core Elements of Antibiotic Stewardship Programs
  • Work with other health care facilities to prevent infections, transmission, and resistance.
  • Require and enforce CDC guidance for infection detection, prevention, tracking and reporting.
  • Ensure your lab can accurately detect infections and alert clinical and infection prevention staff when a drug-resistant organism is present.
  • Know infection and resistance patterns in your facility and in nearby facilities.
  • Require staff to notify the receiving facility about all infections when a patient is transferred.
  • Join or start regional infection prevention efforts.
  • Promote wise antibiotic use.

Core Elements of Antibiotic Stewardship Programs

  1. Leadership Commitment. Antibiotic stewardship is a team effort in which many hospital staff – including physicians, pharmacists, nurses, and administrators – play an important role.
  2. Accountability. Hospitals must appoint a single leader, such as a physician, who is responsible for program outcomes.
  3. Drug Expertise. Hospitals must designate a single pharmacist who can lead initiatives to improve antibiotic use among patients.
  4. Action. Hospitals must implement a systematic approach to evaluating patients’ needs for antibiotics.
  5. Tracking. Monitoring the impact of antibiotics on patients and patient outcomes is essential to ensuring that antibiotics are prescribed only in cases where they treat bacterial infections.
  6. Reporting. Doctors, nurses, and other key staff must regularly share information with all hospital stakeholders.  
  7. Education. Education must be provided regularly to all hospital staff, as well as patients and their families.

Please refer to the CDC’s full guide for more information:

For hospitals: https://www.cdc.gov/antibiotic-use/healthcare/pdfs/core-elements.pdf

For nursing homes: https://www.cdc.gov/longtermcare/pdfs/core-elements-antibiotic-stewardship.pdf

For small and critical access hospitals: https://www.cdc.gov/antibiotic-use/healthcare/pdfs/core-elements-small-critical.pdf

You will need to enter your name and email address to view each recording.

Florida Department of Health Antibiotic Stewardship

Presented by Tammy Jernigan, ARNP, MSN, CIC – November 20, 2015

Objectives:

  • Provide an overview of antibiotic stewardship program components for hospitals
  • Discuss the use and misuse of antibiotics in the U.S.
  • Identify strategies to improve patient care through antibiotic stewardship programs
  • Summarize the National Action Plan for Combating Antibiotic-Resistant Bacteria

Recording - Slide Set

Multi-Drug Resistant Gram Negative Bacteria and Antimicrobial Stewardship

Presented by Brian Meister, Pharm.D, BCPS – February 19, 2016

Objectives:

  • Definition and evolution of gram negative resistance
  • Epidemiology of gram negative resistance
  • Treatment of resistant organisms
  • Stewardship role of hospital pharmacist

No recording available - Slide Set

Clostridium difficile Infection (CDI) Diagnosis, Treatment, and Prevention

Presented by Ed Septimus, MD. FACP, FIDSA, FSHEA – May 13, 2106

Objectives:

  • Epidemiology and transmission
  • Diagnostic options
  • Treatment
  • Prevention

Recording - Slide Set

An Introduction to Judicious Use of Antibiotics

Presented by Ivan Guerrero, MD – September 30, 2016

Objectives:

  • Discuss untoward effects of antibiotic use
  • Define antibiotic stewardship
  • Describe 6 goals of antibiotic stewardship programs
  • Describe a rationale for antibiotic selection
  • Describe directed and empiric antibiotic therapy
  • Describe and give examples of 4 tenets of appropriate antibiotic use

No recording available - Slide set

Antibiotic Stewardship in Long-Term Care: Background and Implementation Strategies

Presented by Joseph M. Mylotte, MD – November 28, 2016

Objectives:

  • To understand the importance of antibiotic stewardship in LTC by reviewing the use of antibiotics and their adverse effects in this setting
  • To review the CDC core elements of antibiotic stewardship for LTC
  • To provide methods to implement the CDC core elements in individual LTC facilities

No recording available - Slide Set

Impact of Antimicrobial Stewardship Program

Presented by Ripal Jariwala, Pharm.D, AAHIVP – February 2017

Objectives:

  • Provide an overview on antimicrobial stewardship programs (ASP)
  • Describe the antimicrobial stewardship program at Tampa General Hospital (TGH) and its progression
  • List the potential barriers that may impact ASP 
  • Discuss the regulatory standards related to ASP

Recording - Slide Set

Building a Joint Commission Ready Antimicrobial Stewardship Program

Presented by Florian Daragjati, Pharm.D, BCPS – June 6, 2017

Objectives:

  • Understand the 2020 goals, which are part of the national strategy for combating antimicrobial resistant organisms
  • Understand and be able to describe the elements of performance for Joint Commission Standard MM 09.01.01
  • Understand the importance of engaging stakeholders within the organization to improve antimicrobial prescribing
  • Discuss the role of testing stewardship as an important component of antimicrobial stewardship

Recording - Slide Set

Building a Strong Antimicrobial Stewardship Program in a Community Hospital with Limited Resources

Presented by Sue Lau, Pharm.D – September 21, 2017

Objectives:

  • Evaluate the importance of an Antimicrobial Stewardship Program (ASP)
  • Apply the steps of building up an ASP from scratch with limited resources
  • Identify ways to sustain the ASP
  • Show the accomplishments from the ASP at Dr. P. Phillips Hospital

Recording - Slide Set

The Crucial Role of Epidemiology in Healthcare Antimicrobial Stewardship

Presented by John E. McGowan, Jr., MD – November 14, 2017

Objectives:

  • Describe the role of epidemiology in health care antimicrobial stewardship (HAS)
  • List three practical epidemiologic activities for HAS
  • Describe how the HAS team uses epidemiologic data
  • Give one example of how local HAS prevalence surveys are useful in addition to NHSN data
  • Summarize why epidemiologic activities are crucial to HAS

Recording - Slide Set

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