Protecting Patients and Stopping Outbreaks
Antibiotic resistance in healthcare settings is a significant threat to public health. Because almost all Americans will receive care in a medical setting at some point, antibiotic resistance can affect anyone. By preventing antibiotic resistance in healthcare settings, patients’ lives are better protected and their health can be preserved.
Antibiotic-resistant infections can happen anywhere. Data show that most happen in the general community; however, most deaths related to antibiotic resistance happen in inpatient healthcare settings, such as hospitals and nursing homes
Inpatient Healthcare Providers
- Know what types of drug-resistant infections are present in your facility and patients.
- Request immediate alerts when the lab identifies drug-resistant infections in your patients.
- Alert receiving facility when you transfer a patient with a drug-resistant infection.
- Protect patients from drug-resistant infections.
- Follow relevant guidelines and precautions at every patient encounter.
- Prescribe antibiotics wisely.
- Remove temporary medical devices such as catheters and ventilators as soon as they are no longer needed.
Health Care CEOs, Medical Officers, and Other Healthcare Facility Leaders
- Require and strictly enforce CDC guidance for infection detection, prevention, tracking, and reporting.
- Make sure your lab can accurately identify infections and alert clinical and infection prevention staff when these bacteria are present.
- Know infection and resistance trends in your facility and in the facilities around you.
- When transferring a patient, require staff to notify the other facility about all infections.
- Join or start regional infection prevention efforts.
- Promote wise antibiotic use.
Resources for Healthcare
- Get Smart for Healthcare
- Get Smart: Know when Antibiotics Work for Healthcare Professionals
- Core Elements of Hospital Antibiotic Stewardship Programs
- HICPAC: Management of Multidrug-Resistant Organisms In Healthcare Settings, 2006
- Antibiotic Rx in Hospitals: Proceed with Caution
- Stop Infections from Lethal CRE Germs Now
- Stopping C. difficile Infections
- 2012 CRE Toolkit - Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE)
Antibiotic-resistant infections outside of the hospital setting were rare until recently.
- Prescribing antibiotics when they are not needed or prescribing the wrong antibiotic in outpatient settings such as doctors’ offices is common.
- In some cases, doctors might not order laboratory tests to confirm that bacteria are causing the infection, and therefore the antibiotic might be unnecessarily prescribed.
- In other cases, patients demand treatment for conditions such as a cold when antibiotics are not needed and will not help.
Resources for Outpatient Healthcare Settings
- Get Smart: Know when Antibiotics Work
- Adult Treatment Recommendations for Outpatient Healthcare Professionals
- Pediatric Treatment Recommendations for Outpatient Healthcare Professionals
- Resources for Community Pharmacists
- Materials and References for Outpatient Healthcare Professionals
Steps to Combat Antimicrobial Resistance in Outpatient Settings
|Steps||Suggestions for implementation|
|Improve antibiotic prescribing|
|Use current clinical guidelines to support rational and|
appropriate antibiotic prescribing
|Share unremarkable finding during the examination (e.g., "no inflammation" or "normal breathing"), while acknowledging the patient is sick.|
Determine the likelihood of a bacterial infection, especially for upper respiratory track infections.
Provide a specific diagnosis (e.g., "viral bronchitis" vs "virus")
Weigh benefits vs harms of antibiotics
|Communicate with patients about when and why antibiotics may not be necessary||Explain that unnecessary antibiotic use can be harmful (e.g., adverse effects associated with antibiotic use, potential resistance development)|
Explain that treating viral infections with antibiotics does not work
Explicitly plan treatment of symptoms by describing the expected normal course of the illness, and instruct patients to call or come back if symptoms persist or worsen; consider providing care packages with non antibiotic therapies
|Educate patients if an antibiotic is needed||Encourage adherence|
Discuss potential adverse effects
|Create an office environment that promotes a reduction in antibiotic use||Start the process in the waiting room with videos, posters, and other materials|
Hang posters in examination rooms to display a commitment to not prescribe antibiotics for viral infections
Involve office personnel in the reinforcement of the physician's messages
|Prevent infections and the spread of resistant bacteria|
|Ensure that all patients get recommended vaccinations|
|Provide pneumococcal and influenza vaccines (to help avoid secondary bacterial infections)., which are particularly important|
Counsel patients onhow to avoid spreading or becoming infected with resistant pathogens in the community (e.g., methicillin-resistant Staphylococcus aureus)
Follow recommendations for infections control in outpatient settings (http://www.cdc.gov/hai/settings/outpatient/outpatient-care-guidelines.html)
|Monitor antibiotic-resistant infections|
|Report notifiable diseases||Report to the health department any diseases caused by bacteria on the Centers of Disease Control and Prevention's list of urgent and serious pathogens (reporting requirements differ by U.S. state and Canadian province); antibiotic-resistant strains of some bacteria (e.g., methicillin-resistant Staphylococcus aureus) are reportable in some states|
|Be alert for treatment failures||Consider the possibility of antibiotic resistance in cases of treatment failure; obtain laboratory confirmation and notify local public health authorities in case of unusual or unexpected treatment failure|
|Microorganism ||Notable information|
|Clostridium difficileA1,A2||Deaths related to C. difficile increased 400% between 2000 and 2007, in part because of a stronger strain|
Most infections are connected to receiving medical care
Hand sanitizer does not kill C. difficile, and hand washing may not be sufficient
|Carbapenem-resistant EnterobacteriaceaeA3||Difficult to treat and, in some cases, untreatable|
Kills up to one-half of patients who get bloodstream infections
Easily spreads antibiotic resistance to other bacteria
|Drug-resistant Neisseria gonorrhoeaeA4||Cases in the United States are more prevalent in the West and among men who have sex with men|
All patients treated for gonorrhea should routinely be offered condoms, referred for risk-reduction counseling, and retested for gonorrhea three months later
|Multidrug-resistant AcinetobacterA5||Increasingly common in U.S. health care facilities; hard to treat|
Noted in U.S. service members wounded in Iraq and Afghanistan
|Drug-resistant CampylobacterA6||Most cases are sporadic and not part of outbreaks|
Ciprofloxacin (Cipro) resistance to Campylobacter increased from 12% in 1997 to 24% in 2011
|Fluconazole- (Diflucan-) resistant Candida (fungus)A7-A9||Antifungal resistance in mucosal candidiasis varies by species|
|Extended spectrum β-lactamase producing EnterobacteriaceaeA10,A11||Infections have become more common in recent years|
Once confined largely to hospitals, these bacteria, especially Escherichia coli, are increasingly common in community-acquired infections, particularly urinary tract infections
|Vancomycin-resistant EnterococcusA12-A14||Enterococci are the fifth most common cause of health care–associated infections|
Most likely to be found in urine and in wounds; may pose a risk for spreading in the outpatient setting
|Multidrug-resistant Pseudomonas aeruginosaA15,A16||About 8% of all health care–associated infections are caused by P. aeruginosa; about 13% of severe P. aeruginosa health care–associated infections are multidrug resistant|
P. aeruginosa may be isolated from outpatients with otitis, skin rash, and urinary tract infections
|Drug-resistant non-typhoidal SalmonellaA17,A18||Estimated 1.2 million cases occur each year in the United States; most go unreported|
About 100,000 of cases (8%) are caused by drug-resistant Salmonella
Outbreaks occur each year; some involve multiple states and/or national distribution
|Drug-resistant Salmonella serotype TyphiA19||Estimated 5,700 cases annually in the United States|
Most (up to 75%) are acquired during international travel
Increasing resistance to antibiotics, especially fluoroquinolones
|Drug-resistant ShigellaA20||High-risk groups include children in day care centers (younger than five years) and their caregivers, men who have sex with men, international travelers, and persons in custodial institutions|
Increasing resistance to ciprofloxacin and azithromycin (Zithromax) is of particular concern
|MRSAA21-A23||Although overall cases of invasive MRSA are declining, the proportion of community-associated infections has increased|
MRSA should be considered in the differential diagnosis of skin and soft tissue infections
|Drug-resistant Streptococcus pneumoniaeA24||The increasing threat of antibiotic resistance makes vaccination according to the Advisory Committee for Immunization Practices’ recommendations for children and adults more important|
|Drug-resistant TBA25,A26||The number of TB cases is declining in the United States|
63% of TB cases in the United States occur among foreign-born persons
The proportion of primary multidrug-resistant TB cases occurring among foreign-born persons has been increasing
|Vancomycin-resistant Staphylococcus aureusA27||Rare; 13 cases have been identified in the United States since 2002|
The severity of the consequences of S. aureus resistance to vancomycin require continued vigilance for this pathogen
|Erythromycin-resistant Group A StreptococcusA28||Penicillin remains the drug of choice, but the resistance to other drugs needed for patients allergic to penicillin is worrisome|
Of samples tested by the CDC, 10% were erythromycin-resistant and 3.4% were clindamycin-resistant
|Clindamycin-resistant Group B StreptococcusA29||Neonates, pregnant women, and persons older than 65 years with underlying conditions are at highest risk|
Penicillin remains the drug of choice, but the resistance to other drugs needed for patients allergic to penicillin is worrisome
NOTE: Additional information on the microorganisms in this table can be found in the CDC’s antibiotic threats report at http://www.cdc.gov/drugresistance/threat-report-2013/index.html (accessed March 27, 2014).
CDC = Centers for Disease Control and Prevention; MRSA = methicillin-resistant Staphylococcus aureus; TB = tuberculosis.
- Page last reviewed: July 19, 2010
- Page last updated: July 22, 2010
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