Responding to serious concerns that bacteria which cause meningitis, pneumonia, and other serious infections are becoming more resistant to antimicrobials, an international panel of public health experts convened today to discuss ways of reducing antimicrobial resistance by preventing infections, reducing the number of prescriptions written, and improving patient and physician education.
The panel, which met here at the 30th International Educational and
Scientific Symposium of the Society of Critical Care Medicine (SCCM), is
concerned that the rate of antimicrobial resistance, especially in intensive
care units (ICUs), is increasing much faster than the rate of the development
of new drugs to combat these infection-causing microbes. According to the
panel, some bacteria are now resistant to all the first-line drugs useful in
the past, and outbreaks of these organisms, such as Acinetobacter, are
occurring in ICUs around the world.
"Antimicrobials have been one of the major life-saving breakthroughs in
medicine, yet increasing resistance continually threatens our ability to
effectively treat many infections with these agents," said Julie Gerberding,
M.D., M.P.H., Director of The Division of Health Care Quality Promotion at The
Centers for Disease Control and Prevention in Atlanta. "To combat this
growing epidemic, physicians have a responsibility to more wisely use
antimicrobials by not over-prescribing these agents or opting to prescribe the
most powerful agents initially. Likewise, patients and their families can
help by not demanding antimicrobials if not necessary whenever they see their
Every year, nearly 80 million antimicrobial prescriptions are written for
patients in the United States, and some estimates suggest that half of these
may not be necessary. Often, antimicrobials are incorrectly prescribed for
patients with viral infections, though such infections cannot be treated with
these agents. According to Jean M. Carlet, M.D., Chief of Services,
Department of Critical Care at the Foundation Hospital St. Joseph in Paris,
and co-chair of the 30th SCCM Education and Scientific Symposium,
inappropriate use of antimicrobials is a main reason why bacteria develop
When bacteria are constantly exposed to antimicrobials, they can develop
slight genetic changes that help them become resistant to subsequent
treatment. Once this resistance develops, bacteria can pass this genetic
trait onto other bacteria. Then when antimicrobials are used, the resistant
bacteria survive and thrive.
"In ICUs worldwide, bacterial infections are a major cause of death among
critically ill patients. But the rise of antimicrobial resistance has
markedly limited the number of treatment options available," Dr. Gerberding
said. "There are fundamental steps, such as improving antimicrobial use in
the ICU, we can take today to stop this public health threat, and ensure that
future generations benefit from these important therapies."
"Antimicrobial therapy must be viewed as a two step process -- the first
is to effectively treat patients who are severely infected, and the second is
to prevent the acquisition of resistance," Dr. Carlet said. "Daily
reassessment of antimicrobial treatment strategies is mandatory in the ICU in
order to reach these goals."
During the Symposium, the medical experts identified the following steps
that physicians, healthcare professionals, and patients can take to decrease
- Preventive Measures -- Increasing the use of vaccines to prevent
infection and thereby reduce the need for antimicrobials.
Decreasing the use of medical devices (i.e., catheters) in patients
in ICUs also can help reduce the risk of infection.
- Accurate Diagnosis -- Correctly identifying the cause of the
infection, and understanding how that microbe responds to specific
agents, in order to prescribe the right antimicrobial.
- Targeted Treatment -- Treat the patient with a regimen effective
against likely microbes. One or two days later, when more
information is known, narrow the regimen to target the causative
- Responsible Use -- Using antimicrobials only when necessary, at the
right dose, and for the proper duration. Also, instructing
physicians to start treatment with a less powerful agent when
appropriate, rather than the "big guns." When bacteria become
resistant to the more powerful agents, the treatment options are
- Improved Hygiene -- Proper hand cleaning, and using gloves and
hospital gowns to prevent the spread of infection.
- Patient Education -- Informing patients and their families about the
proper use of antimicrobials, such as the types of infections these
agents treat and the importance of following the prescribed
Microbial Resistance: A Global Epidemic
Bacteria are increasingly becoming resistant to antimicrobials. For
example, nearly 40 percent of Streptococcus pneumoniae, a common cause of
pneumonia, are resistant to penicillin in parts of Europe, especially Spain
and France. Worldwide, 95 percent of staphylococci are resistant to
penicillin, and more than 40 percent resist methicillin, which was developed
to combat the bacteria's increasing resistance to penicillin. In many ICUs,
more than half of the serious staphylococcal infections are resistant to
methicillin and similar drugs.
Additionally, some infection-causing microbes are now becoming less
susceptible to treatment with glycopeptides, such as vancomycin, which have
been considered the last available class of antimicrobials.