Antimicrobial Resistance: The Big Picture

An Interview With CDC's Steven L. Solomon, MD

Laura A. Stokowski, RN, MS; Steven L. Solomon, MD

Disclosures

September 16, 2013

Editorial Collaboration

Medscape &

In This Article

A Collaborative Effort

Medscape: It is evident from the report that a tremendous effort is going on to address antimicrobial resistance. What more can individuals and groups do?

Dr. Solomon: The problem is still there, and for some microorganisms, the problems are getting worse. We are looking for partnership, engagement, cooperation, and involvement. We have always reached out to clinicians and healthcare professionals to address problems with each of the bacteria described in the report, but now we are trying to do that in a more holistic way. We want people to know what we are doing, what they can do to support our work, and what they can do to address the problem.

In the report, we emphasize 4 core actions that need to be taken to prevent antimicrobial resistance:

• Preventing infections and preventing the spread of resistance;

• Tracking resistant bacteria;

• Improving the use of today's antibiotics/antibiotic stewardship; and

• Promoting the development of new antibiotics and developing new diagnostic tests for resistant bacteria.

For each of the 18 pathogens, we provide specific actions for communities, healthcare professionals, and patients to contribute to and support CDC's efforts to reduce antimicrobial resistance. Examples of actions for healthcare professionals include prevention through infection control; promoting detection, tracking, and reporting resistant infections; being aware of local resistance patterns; removing invasive devices when no longer needed; and notifying receiving facilities of patients' infections when transferring patients between facilities.

Medscape: What efforts are being directed at the prevention of infections and the spread of resistance?

Dr. Solomon: Preventing infections from developing reduces the use of antibiotics, which in turn slows the pace of antibiotic resistance and the spread of resistant bacteria. CDC is working to prevent antimicrobial-resistant infections not just in healthcare settings, but also in the community and in the food supply. Most infections arise in the general community; however, most deaths related to antibiotic resistance occur in healthcare settings.

CDC provides healthcare facilities with infection prevention guidelines and tools to prevent infections, such as the CRE prevention toolkit.

Furthermore, CDC serves as the nation's reference laboratory to identify microorganisms, and it maintains the National Healthcare Safety Network (NHSN) to report and track healthcare-associated infections, allowing facilities and states to identify and address problem areas.

In the past, hospitals were the first places we saw new resistance developing, but resistance can also develop and spread in community settings. Methods of preventing infection and the spread of resistance in the community include safe food preparation, handwashing, using antibiotics appropriately and only when necessary, contact tracing, vaccination, use of treatment guidelines, and promotion of safe sex.

A good example of community-level prevention is the use of the Streptococcus pneumoniae vaccine. Pneumococcal conjugate vaccine (PCV) is an effective tool to prevent infections. Vaccine use has not only reduced the burden of invasive pneumococcal disease, but it has also reduced antibiotic resistance by blocking the transmission of resistant S pneumoniae strains. From 2000 through 2009, PCV7 provided protection against 7 pneumococcal strains, and beginning in 2010, the use of PCV13 expanded that protection to 13 strains. With the wide use of PCV13 since 2010, antibiotic-resistant disease due to the most common cause of invasive S pneumoniae infection among children (serotype 19A) is expected to decline.

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