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Back To Vidyya International Panel Of Public Health Experts Stresses Need For Improved Use Of Antimicrobials To Combat Rising Epidemic Of Drug Resistance

Physicians Urge More Appropriate Prescribing Habits and Increasing Vaccinations

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 physician."

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 resistance.

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 antimicrobial resistance:

  • 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 organism.

  • 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 decreased.

  • 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 treatment regimen.

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.

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Editor: Susan K. Boyer, RN
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