Regional Networks Could Slow Antibiotic-Resistant Infections

Troy Brown, RN

August 05, 2015

Antibiotic-resistant infections strike at least two million people in the United States each year, killing at least 23,000, according to the Centers for Disease Control and Prevention (CDC). Now modeling experiments show that if public health authorities and healthcare facilities in a given region work together they could reduce the number of carbapenem-resistant Enterobacteriaceae (CRE) infections by nearly 75% in 5 years.

"No one facility can stop this because the outbreak moves across facilities around a community. When one facility is preventing infections but a second isn't, transferring patients can reinfect the facility that was at first clear of infections. Lack of coordination puts patients at higher risk," said CDC director, Thomas Frieden, MD, MPH, during a press briefing August 4.

Rachel B. Slayton, PhD, from the CDC's National Center for Emerging and Zoonotic Infectious Diseases, and colleagues also reported their findings August 4 in Morbidity and Mortality Weekly Report.

"With effective action now, including nationwide antibiotic stewardship efforts and interventions to prevent spread of antibiotic-resistant infections, an estimated 619,000 infections caused by three problematic antibiotic-resistant [healthcare-associated infections] or [Clostridium difficile infections], and 37,000 deaths among infected patients might be averted nationally over the next 5 years," the authors write.

Dr Slayton and colleagues developed two models, a smaller, 5-year model and a larger, 15-year one. In the small-scale model, the team included 10 healthcare facilities composed of four acute-care hospitals (including one long-term acute-care hospital) and six free-standing nursing homes that serve adult patients.

With currently used infection-control methods, the model predicted that 2000 patients would contract CRE over 5 years, with 12% of the overall patient population in the area affected.

If facilities in the model independently improved their infection control practices the model predicts some improvement, with 1500 patients infected, or 8% of the overall patient population in the network.

By contrast, when the facilities in the model worked together in a coordinated manner to prevent infections and inform each other of CRE issues before transferring patients, the overall infection rate is dramatically reduced. In this case, just 400 patients, or 2% of the total patient population, were predicted to contract CRE over 5 years.

"Compared with independent efforts, a coordinated response to prevent CRE spread across a group of inter-connected health care facilities resulted in a cumulative 74% reduction in acquisitions over 5 years in a 10-facility network model," the researchers write.

In the large-scale model, which simulated a regional network of 28 acute-care hospitals (including five long-term acute-care hospitals) and 74 free-standing nursing homes serving adult patients, the results were similar, if somewhat more modest. In that scenario, there was a 55% reduction over 15 years.

"We must transform our public health response to turn the tide. The coordinated response [the new study] describes is a forward-looking approach," said Beth Bell, MD, MPH, director of CDC's National Center for Emerging and Zoonotic Infectious Diseases.

Two-Part Approach Needed

The new models and report make clear that a two-part approach is needed:

(1) Public health departments must track and alert healthcare facilities to drug-resistant bacteria infections in their area and the threat of drug-resistant bacteria from other facilities.

(2) Healthcare facilities must work together and with public health authorities to implement shared infection-control measures to prevent the spread of antibiotic-resistant bacteria and C. difficile between facilities.

"Action at the state level is particularly critical for this approach. To implement a coordinated approach…states need to be able to identify…all the healthcare facilities in their area and know how they're connected with regard to how they share patients. They need additional staff to improve these connections and to coordinate the coordination that needs to happen between the healthcare facilities in their area," said senior author John Jernigan, MD, director, Office of Prevention Research and Evaluation, Division of Healthcare Quality Promotion, CDC, during the press briefing.

"They need to develop a communication plan so information can be smoothly and seamlessly shared between these facilities. Very importantly, they need to work with CDC to use the data available to them for action to better prevent infections and improve antibiotic use in healthcare," Dr Jernigan explained.

Additional information can be found at

The authors and other speakers have reported no conflicts of interest.

MMWR. Published online August 4, 2015. Full text


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