Infections caused by multidrug-resistant organisms (MDROs) have dramatically increased in all parts of the world in the past decade.
Antibiotic resistance, or the “silent tsunami,” occurs when germs like Staphylococcus aureus bacteria and Candida auris fungi adapt to defeat common antibiotics designed to destroy them.
This means the germs remain after treatment and continue to grow, potentially leading to infections that are difficult or impossible to treat. In many cases, MDRO infections can cause a fatal chain reaction that can extend hospital stays, increase readmissions and require additional medical visits that can result in a loss of productivity, prolonged antibiotic therapy and home health care treatment. Awareness is key to stopping the spread of MDROs and the invasive and deadly infections they cause.
Considering the impact of antimicrobial resistance (AMR), this is a public health threat.
According to a recent Centers for Disease Control and Prevention (CDC) report released in November 2019, antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the U.S. each year. That means, on average, someone in the U.S. gets an antibiotic-resistant infection every 11 seconds, and every 15 minutes someone dies. The infection control community estimates that 700,000 deaths (PDF) each year can be attributed to antimicrobial resistance globally. Twenty-seven million people in the U.S. receive unnecessary antibiotics for respiratory infections annually and 8% to 65% of urinary tract infections are not treatable with a regularly prescribed antibiotic.
In September 2019, the U.S. Department of Health and Human Services and the CDC applauded the yearlong AMR Challenge commitments from global and national government organizations, nonprofit organizations and private companies to fight against antimicrobial resistance at the United Nations General Assembly in New York City.
According to a 2016 report, antimicrobial resistance will cause 10 million deaths per year worldwide by 2050, eclipsing the World Health Organization’s 2018 estimate of 9.6 million global cancer deaths. Despite awareness in healthcare, government, and the more recent attention in the media, MDROs continue to increase throughout the world.
Everyone is responsible for helping to prevent the spread of MDROs because at any time, cross-contamination can occur from person to person or from a person to an environment.
A bundled approach is necessary for every healthcare facility across the continuum of care, including physician offices, acute care hospitals, inpatient rehabilitation facilities, long-term acute care hospitals, nursing homes and assisted living facilities among others. The strategies to include in the bundle should be universal and designed to reduce all infections rather than being pathogen-specific.
A bundled approach should include optimal hand hygiene, daily environmental cleaning and disinfecting, prudent use of contact precautions or enhanced barrier precautions, decolonization, antimicrobial stewardship, vaccinations and increased staff education with ongoing training to help reduce the prevalence of MDROs. One strategy does not surpass another; all are equally important and essential in the fight against MDROs.
In a 2006 study on pathogen persistence on inanimate surfaces, Kramer described how both MDROs and viruses can persist on dry inanimate surfaces from one day (24 hours) to over 30 months (21,914.5 hours) for some pathogens. Another study reported that 12 states identified approximately 1600 outbreaks from 2010 to 2013 in assisted living facilities, with influenza and norovirus infections having the highest prevalence. This illustrates the importance of several infection control strategies, including hand hygiene, environmental cleaning and disinfection, contact precautions and vaccinations.
Decolonization with antiseptic products is one strategy that has shifted from targeted to universal and challenged the use of active surveillance to decrease MDROs in interconnected healthcare facilities as well as in all patients’ types, including preoperative patients, inpatients and discharged patients. This proactive method has proven to be extremely effective and cost-efficient. More recently, the CDC has updated their core strategies to include decolonization to fight S. aureus, a common and prevalent pathogen that causes healthcare associated infections, including central line-associated bloodstream infections and surgical site infections.
However, one strategy that everyone has learned since childhood is to wash your hands after using the bathroom. This prompt is visually present in public places like hospitals, restaurants, schools, and other high traffic public facilities. However, a recent study in The Lancet Infectious Diseases showed the failure to wash hands after going to the bathroom is behind the spread of the MDRO Escherichia coli, which causes urinary tract infections and more dangerous and deadly bloodstream infections. Antibiotics like penicillin and cephalosporin are no match for this extended spectrum beta-lactamases E. coli.
Nevertheless, using antibiotics responsibly and appropriately is key. Antibiotics have saved millions of lives, but they can come with side effects, like any medication, and can lead to antimicrobial resistance. A review of numerous randomized controlled trials of 12 different infection diagnoses demonstrated shorter equals better for antibiotic stewardship. Antibiotic stewardship is a great way to make sure healthcare providers are giving the right drug in right dose at right time for the right duration to the right patient.
Are you a resistance fighter?
If you are reading this article, then the answer is yes.
The solution lies in leveraging the proper infection prevention strategies, which require a bundled approach to interventions, to help stop infections before they start. Regardless of whether you are a healthcare provider, a patient, a family member, a student or a restaurant worker, everyone can break the chain of spreading germs, fungus and bacteria to prevent MDRO infections. Continuing to stay abreast of infection prevention information from local public health departments and government health organizations like the CDC can prepare you to respond to current and emerging trends in infection prevention and MDRO outbreaks.
Rosie Lyles, M.D., M.H.A., M.S.c., is the director of clinical affairs at Medline.