The latest edition of Vital Signs, a monthly report from the US Centers for Disease Control and Prevention (CDC), includes mathematical modeling that projects increases in drug-resistant organisms and Clostridium difficile (C. difficile) infections unless immediate, nationwide improvements are made in infection control and antibiotic prescribing.
The promising news is that CDC modeling projects that a coordinated approach—that is, healthcare facilities and health departments in an area working together—could prevent up to 70% of life-threatening carbapenem-resistant Enterobacteriaceae (CRE) infections over 5 years. Additional estimates show that national infection control and antibiotic stewardship efforts led by federal agencies, healthcare facilities, and public health departments could prevent 619,000 antibiotic-resistant and C. difficile infections and save 37,000 lives over 5 years.
Antibiotic-resistant germs, those that no longer respond to the drugs designed to kill them, cause more than 2 million illnesses and at least 23,000 deaths each year in the United States. C. difficile caused close to half a million illnesses in 2011, and an estimated 15,000 deaths a year are directly attributable to C. difficile infections.
The report recommends the following coordinated, two-part approach to turn this data into action that prevents illness and saves lives:
- Public health departments track and alert healthcare facilities to drug-resistant germ outbreaks in their area and the threat of germs coming from other facilities.
- Healthcare facilities work together and with public health authorities to implement shared infection control actions to stop the spread of antibiotic-resistant germs and difficile between facilities.
Thomas Frieden, MD, MPH, CDC.
“Antibiotic-resistant infections in healthcare settings are a growing threat in the United States, killing thousands and thousands of people each year,” says CDC Director Tom Frieden, MD, MPH. “We can dramatically reduce these infections if healthcare facilities, nursing homes, and public health departments work together to improve antibiotic use and infection control so patients are protected.”
The Vital Signs report shows that C. difficile and drug-resistant bacteria—such as CRE, methicillin-resistant Staphylococcus aureus (MRSA), and resistant Pseudomonas aeruginosa—spread inside of and between healthcare facilities when appropriate infection control actions are not in place and patients transfer from one healthcare facility to another. These infections can lead to serious health complications, including sepsis or death. Even facilities following recommended infection control and antibiotic use practices are at risk when they receive patients who carry these germs from other healthcare facilities.
The model shows how coordination could reduce CRE over the course of 5 years after the drug-resistant bacteria enters 10 facilities in an area sharing patients. For example:
- The current approach is insufficient for protecting patients, and results in 2,000 patients—12% of patients in the area—getting CRE.
- When a facility acts alone to enhance its infection control practices, the situation improves. This independent effort results in 1,500 patients getting CRE, affecting 8% of patients. While an important improvement, this strategy is not sufficient to protect patients fully.
- With a coordinated approach in which facilities work together to prevent infections and notify one another other about CRE issues before transferring patients, the modeling shows far fewer patients at risk. In this scenario, 400 patients are predicted to get CRE, affecting only 2% of patients.
The report also describes the importance of public health departments taking the lead to:
- Identify healthcare facilities in the area and know how they are connected.
- Dedicate staff to improve connections and coordination with healthcare facilities in the area.
- Work with CDC to use data for to prevent infections and improve antibiotic use in healthcare.
- Know the antibiotic resistance threats in the area and state.
Beth Bell, MD, MPH, CDC.
“We must transform our public health response to turn the tide. The coordinated response this Vital Signs report describes is a forward-looking approach,” says Beth Bell, MD, MPH, director of CDC’s center for emerging and zoonotic infectious diseases. “The President’s FY 2016 budget would accelerate efforts to strengthen our response and improve antibiotic stewardship in healthcare facilities.”
Complementing public health coordination, the report recommends that hospital owners and healthcare facility administrators consider steps to:
- Implement systems to alert receiving facilities when transferring patients who have drug-resistant germs.
- Review and perfect infection control actions in each facility.
- Make leadership commitments to join area healthcare-associated infection (HAI)/antibiotic resistance prevention activities.
- Connect with public health departments to share data about antibiotic resistance and other HAIs.
- Provide clinical staff access to prompt and accurate laboratory testing for antibiotic-resistant germs.
Michael Bell, MD, CDC.
“Patients and their families may wonder how they can help stop the spread of infections,” says Michael Bell, MD, deputy director of CDC’s division of healthcare quality promotion. “When receiving healthcare, tell your doctor if you have been hospitalized in another facility or country, wash your hands often, and always insist that everyone have clean hands before touching you. Ask your healthcare providers what they and the healthcare facility in your area do to coordinate with others to protect you and your family from an antibiotic-resistant or C. difficile infection.”
The data in the Vital Signs report come from both mathematical modeling and analysis estimates. CDC used two mathematical simulation models to estimate the impact of the coordinated approach in preventing the spread of antibiotic-resistant germs within a group of healthcare facilities in an area. Data from CDC’s National Healthcare Safety Network and Emerging Infections Program informed projections of the number of infections and deaths in the United States.
With investments during the next 5 years, CDC’s efforts to combat C. difficile infections and antibiotic resistance under the National Strategy to Combat Antibiotic Resistant Bacteria, in collaboration with other federal partners, will enhance national capabilities for antibiotic stewardship, outbreak surveillance, and antibiotic resistance prevention. According to CDC, these efforts hold the potential to cut the incidence of C. difficile, CRE, and MRSA by at least half.
