A coordinated approach to infection control and antibiotic stewardship would dramatically reduce the number of people affected by antibiotic-resistant pathogens and health care–associated infections (HAIs), saving tens of thousands of lives and billions of dollars over the next 5 years, according to a federal report.
With a nationwide prevention and antibiotic stewardship program, the total number of HAIs could be reduced by 619,000 over the next 5 years, saving 37,000 lives and reducing direct medical costs by $7.7 billion, Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC), said in a telebriefing sponsored by the agency.
The coordinated approach requires both a public health tracking and alerting system and robust interfacility infection control practices. “Facilities that go it alone can’t effectively protect their own patients,” he said.
A CDC Vital Signs report projected outcomes for institution-based versus coordinated responses to antibiotic-resistant infections, predicting infections and deaths from 2014-2019 in a series of three scenarios.
Rachel Slayton, Ph.D., of the Center for Emerging and Zoonotic Infectious Diseases, used carbapenem-resistant Enterobacteriaceae (CRE) as the test case to determine the effect size of coordinated compared with institution-based infection control and alerting practices.*
She and her coauthors projected that the number of health care-associated CRE infections would rise about 10% over the next 5 years, from 310,000 to 340,000, under current practices. Using these prevalence figures, a coordinated approach would result in CRE prevalence within a health care network of just 2% after 5 years, compared with a 12% baseline prevalence and an 8.6% prevalence with augmented individual efforts.
“Two percent is still two percent too much, but it’s still a whole lot better than 12%,” said Dr. Frieden.
Infection control practices that are enhanced by interfacility coordination may include maintaining regional databases that permit alerts when an individual with an HAI transfers from one facility to the other; having inter-institution agreement about best practices for gowning, gloving, and isolation; and commencing enhanced screening for HAIs when public health officials identify a potential outbreak. Antibiotic stewardship is also enhanced when institutions explicitly agree to follow best prescribing practices.
Implementation of the coordinated approach would be supported by the CDC’s Antibiotic Resistance Solutions Initiative, with $264 million requested in the federal fiscal year 2016 budget for a broad set of programs. Part of this amount would provide for funding of a coordinated prevention approach in all 50 states, with support for state and local health departments, and a network of laboratory facilities for improved surveillance for resistant pathogens.
On Twitter: @karioakes
*CORRECTION 8/9/2015: The original version of this story misidentified the test case organism.