Seven Deadly Sinners

March 8th, 2016

Once consigned to separate silos, infection prevention and antibiotic stewardship are starting to show signs of a powerful partnership.

Progress has been made against healthcare associated infections, most dramatically evidenced by a 50% decrease in central line-associated blood stream infections from 2008 to 2014, the Centers for Disease Control and Prevention reports.

“We recommend three critical strategies, doctors, nurses and other healthcare providers need to take with every patient, every interaction, to prevent infections and stop the spread of antibiotic resistance,” Tom Frieden, MD, CDC Director said at a recent press conference. “First is preventing the spread of bacteria between patients. Second is preventing infections related to catheters and surgeries. And third, is improving antibiotic use through antibiotic stewardship."

Though HAI reductions have occurred there are seven problem pathogens that are proving persistently dangerous to patients. The Attila the Hun among these bugs is currently Clostridium difficile, which kills some 15,000 patients a year and has been reduced only by an incremental 8% between 2011 and 2014. C. diff is not an antibiotic resistant pathogen in the classic sense, but a byproduct of overusing broad spectrum antibiotics that kill off commensal bacteria and leave the patient’s gut vulnerable to what the CDC graphically terms “deadly diarrhea.”

Thus antibiotic stewardship and rigorous infection control must be combined to prevent C. diff, a spore former that is notoriously difficult to remove from healthcare worker hands and contaminated objects and surfaces.

The six other antibiotic-resistant bacteria on the CDC’s enemies list are:

• CRE (carbapenem-resistant Enterobacteriaceae)
• MRSA (methicillin-resistant Staphylococcus aureus )
• ESBL-producing Enterobacteriaceae (extended-spectrum ß-lactamases),
• VRE (vancomycin-resistant enterococci),
• multi-drug resistant Pseudomonas aeruginosa
• multi-drug resistant Acinetobacter.