Of the 35 million patients admitted to acute care facilities in the United States each year, approximately 5 percent, or 1.75 million patients, contract hospital-acquired infections (HAI). Life-threatening blood stream infections account for approximately 10 percent of these, leading to 30,000-70,000 deaths each year.1
Treatment of HAI is complicated by the increased prevalence of antibiotic resistant strains of bacteria, such as methicillin-resistant staphylococcus aureus (MRSA). In order to combat the emergence of antibiotic resistant pathogen strains, several measures are required: antimicrobial stewardship, accurate and prompt identification of the pathogen, decreased antibiotic use and timely treatment of the infection.
Antimicrobial Use
Timely, appropriate, and adequate antimicrobial use decreases:
The emergence of antibiotic resistant strains of bacteria
Antibiotic over-prescription
Patient care costs
Patient disability and death
In addition, measures such as hand-washing and using antimicrobial-treated devices
(for example, catheters) have been shown to decrease the spread of infection in the
hospital setting.
Accurate and Prompt Pathogen Identification
When they suspect infection, clinicians often prescribe a broad-spectrum antibiotic until they can confirm the presence or absence of infection and accurately identify the pathogen responsible.
Once an infection has been confirmed, the pathogen must be identified quickly so that suitable antimicrobials can be administered to the patient. Prompt identification decreases the time that the patient is taking broad-spectrum antibiotics and increases the likelihood that the infection can be contained.
A conventional microbial culture can take up to 65 hours, or 2.5 days to return a result, but medical researchers are developing new methods for quicker identification. For example, polymerase chain reaction (PCR) and immunofluorescent microscopy2 can decrease identification time to 6 and 3 hours, respectively. Other methods of detection and identification are being investigated for fungal infections. All of these methods need to be assessed in clinical trials, but offer the promise of a significantly faster turnaround for accurate microbial identification.
Decreasing Antibiotic Use
Over-use of antibiotics is a common problem in acute care settings, driving up the cost of care and promoting bacterial resistance. Computerized clinical decision support systems (CCDSS) can be used to interpret individual patient response to the antimicrobials/antibiotics and assist clinicians in prescribing appropriate doses and prescription lengths.
CCDSS provide clinicians and caregivers with a real-time microbiology browser for more directed antibiotic prescription and standardized order sets, resulting in measurable improvements in antibiotic use: They have shown a significant advantage in eight of ten hospitals where tested.3,4
Further development, analysis and incorporation of CCDSS in ICU settings will decrease antibiotic mismatches, improve optimal timing of antibiotic use, decrease hospital length of stay and cost of care, decrease antibiotic usage, decrease the spread of hospital-acquired infection, and reduce the emergence of new antibiotic resistant strains of bacteria.
References:
1Wenzel, R.P., and Edmond, M.B. (2001) The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 7, 174-177
2Hance, K., Howson, D., Lindsey, M., Ngo, T., and Metzger, S. (2007) Rapid Identification of Live Acinetobacter spp. in Bronchoalveolar Lavage Specimens by Automated Immunofluorescence Microscopy. In [Poster K-392] 47th ICAAC Meeting, Chicago IL, Sept 17th, 2007.
3Thursky, K.A., Buising, K.L., Bak, N., Macgregor, L., Street, A.C., Macintyre, C.R., Presneill, J.J., Cade, J.F., and Brown, G.V. (2006) Reduction of broad-spectrum antibiotic use with computerized decision support in an intensive care unit. Int J Qual Health Care 18, 224-231
4Shebl, N.A., Franklin, B.D., and Barber, N. (2007) Clinical decision support systems and antibiotic use. Pharm World Sci 29, 342-349
