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Preventing the Emergence of Multidrug-Resistant Microorganisms Through Antimicrobial Use Controls: The Complexity of the Problem

Published online by Cambridge University Press:  02 January 2015

William R. Jarvis
William R. Jarvis*
Affiliation:
Investigation and Prevention Branch, Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Hospital Infections Program, MS E-69, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333
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Abstract

Widespread use of antimicrobials in the inpatient and outpatient setting has been associated with the emergence of multidrug-resistant microorganisms. A variety of methods exist to improve the appropriateness of antimicrobial use in the inpatient setting, including guidelines, antimicrobial use evaluations, microbiology laboratory guidance, formulary development and antimicrobial restriction, use of antimicrobial order or automatic stop order forms, and antimicrobial audits. To decrease the selective pressure that leads to development of pathogen resistance and to reduce antimicrobial expenditures, infectious disease, infection control, pharmacy, and administrative staff need to improve clinician use of antimicrobials through development and implementation of antimicrobial use committees. Through the implementation of a comprehensive, multidisciplinary approach to antimicrobial use and development of clinician education programs, inappropriate antimicrobial use can be reduced, patient care can be improved, and substantial cost savings can be realized.

Type
From the Fourth International Conference on the Prevention of Infection
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 8 , August 1996 , pp. 490 - 495
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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References

1. Buckwold, FJ, Ronald, AR. Antimicrobial misuse-effects and suggestions for control. J Antimicrob Chemother 1979;5:129–136.CrossRefGoogle ScholarPubMed
2. Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter-associated bloodstream infection. Infect Control Hosp Epidemiol 1996;17:150–158.Google Scholar
3. Haley, RW, Hightower, AW, Khabbaz, RF, et al. The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals: possible role of the house staff-patient transfer circuit. Ann Intern Med 1982;97:297–308.Google Scholar
4. Panlilio, AL, Culver, DH, Gaynes, RP, et al. Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582–586.Google ScholarPubMed
5. Sirot, D, Sirot, J, Labia, R, et al. Transferable resistance to third generation cephalosporins in clinical isolates of Klebsiella pneumoniae: identification of CTX-1, a novel beta-lactamase. J Antimicrob Chemother 1987;20:323–324.CrossRefGoogle ScholarPubMed
6. Bure, A, Legrand, P, Arlet, G, Jarlier, V, Paul, G, Philippon, A. Dissemination in five French hospitals of Klebsiella pneumoniae serotype K25 harboring a new transferable enzymatic resistance to third generation cephalosporins and aztreonam. Eur J Clin Microbiol Infect Dis 1988;7:780–782.CrossRefGoogle ScholarPubMed
7. Gutmann, L, Ferre, B, Goldstein, FW, et al. SHV-5, a novel SHV-type beta-lactamase that hydrolyzes broad-spectrum cephalosporins and monobactams. Antimicrob Agents Chemother 1989;33:951–956.CrossRefGoogle ScholarPubMed
8. Quinn, JP, Miyashiro, D, Sahm, D, Flamm, R, Bush, K. Novel plasmid-mediated beta-lactamase (TEM-10) conferring selective resistance to ceftazidime and aztreonam in clinical isolates of Klebsiella pneumoniae . Antimicrob Agents Chemother 1989;33:1451–1456.CrossRefGoogle ScholarPubMed
9. Rice, LB, Wiley, SH, Papanicolaou, GA, et al. Outbreak of ceftazidime resistance caused by extended-spectrum beta-lacta-mases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother 1990;34:2193–2199.Google Scholar
10. Burwen, DR, Banerjee, SN, Gaynes, RP, the National Nosocomial Infections Surveillance System. Ceftazidime resistance among selected nosocomial gram-negative bacilli in the United States. J Infect Dis 1994;170:1622–1625.Google Scholar
11. Coronado, VG, Edwards, JR, Culver, DH, Gaynes, RP, the National Nosocomial Infections Surveillance (NNIS) System. Ciprofloxacin resistance among nosocomial Pseudomonas aeruginosa and Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1995;16:71–75.CrossRefGoogle ScholarPubMed
12. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin: United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
13. Morris, JG Jr, Shay, DK, Hebden, JN, et al. Enterococci resistant to multiple antimicrobial agents, including vancomycin. Establishment of endemicity in a university medical center. Ann Intern Med 1995;123:250–259.CrossRefGoogle Scholar
14. Kunin, CM. The responsibility of the infectious disease community for the optimal use of antimicrobial agents. J Infect Dis 1985;151:388–397.CrossRefGoogle ScholarPubMed
15. Page, CP, Bohnen, JMA, Fletcher, JR, McManus, AT, Solomkin, JS, Wittman, DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical use. Arch Surg 1993;128:79–88.Google Scholar
16. Gorbach, SL, Condon, RE, Conte, JE, Kaiser, AB, Ledger, WJ, Nichols, RL. General guidelines for the evaluation of new anti-infective drug for prophylaxis of surgical infections. Evaluation of new anti-infective drugs for surgical prophylaxis. Clin Infect Dis 1992;15(suppl 1):S313–S338.CrossRefGoogle Scholar
17. Counts, GW. Review and control of antimicrobial usage in hospitalized patients: a recommended collaborative approach. JAMA 1977;238:2170–2172.CrossRefGoogle ScholarPubMed
18. Hospital Infection Control Practices Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105–113.CrossRefGoogle Scholar
19. Williams, RR, Gross, PA, Levine, JF. Cost containment of the second-generation cephalosporins by prospective monitoring at a community teaching hospital. Arch Intern Med 1985;145:1978–1981.Google Scholar
20. Shah, MM, Gidcomb, M, Murphy, KF. Antibiotic cost reduction (>50%) for selected diagnosis due to educational efforts compared to 27% cost increase for diagnosis without educational efforts in a community hospital without formulary restriction. Thirty-fifth annual meeting of the Interscience Conference for Antimicrobial Agents and Chemotherapy; September 17-20, 1995; San Francisco, CA. Abstract J91.Google Scholar
21. Lutwich, L, DePaolo, S, Smith, R, et al. Antimicrobial (AB) control system (CS) effect on AB costs compared to the total phar macy budget, 1989-1994. Thirty-third annual meeting of the Infectious Diseases Society of America; September 16-18, 1995; San Francisco, CA. Abstract 151.Google Scholar
22. Roblin, X, Gauzere, BA, Lugagne, N, Chan-Ou-Teung, F, Graber, D, Paganin, F. Preliminary results of the use of a new type of prescription form (NPF) in reducing inappropriate use and antiinfective agents (AA) costs. Fourth International Conference on the Prevention of Infection; May 6-7, 1996; Nice, France. Abstract P605.Google Scholar
23. Soumerai, SB, Avorn, J, Taylor, WC, Wessels, M, Maher, D, Hawley, SL. Improving choice of prescribed antibiotics through concurrent reminders in an educational order form. Med Care 1993;31:552–558.Google Scholar
24. Soumerai, SB, McLaughlin, TJ, Avorn, J. Quality assurance for drug prescribing. Qual Assur Health Care 1990;2:37–58.CrossRefGoogle ScholarPubMed
25. Durbin, WA Jr, Lapidas, B, Goldmann, DA. Improved antibiotic usage following introduction of a novel prescription system. JAMA 1981;246:1796–1800.CrossRefGoogle ScholarPubMed
26. Goldmann, DA, Weinstein, RA, Wenzel, RP, et al. Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. JAMA 1996;275:234–240.Google Scholar
27. Department of Health and Human Services, Centers for Disease Control and Prevention. Draft guideline for isolation precautions in hospitals. Federal Register 1994;59:55552–55570.Google Scholar