May 10, 2001
Doctors control spread of antibiotic-resistant bug
By Michael Stebbins, PhD
NEW YORK, May 10 (Reuters Health) - Doctors were able to control the spread of an antibiotic-resistant bacteria through hospitals in the Midwest by implementing simple infection control methods, according to a report.
In the Siouxland region of Iowa, Nebraska and South Dakota, bacteria known as enterococci that are resistant to the commonly used antibiotic vancomycin were first detected in 1996 and became widespread in the 32 hospitals in the region.
Antibiotic resistance is a major problem worldwide, and hospitals are ground zero since infections and antibiotics are part of everyday life in these settings.
"Antibiotic resistant [bacteria] are increasing in prevalence and cause many healthcare-associated infections and are estimated to cost approximately $4 billion annually," according to Dr. Belinda Ostrowsky, the lead author of the study. "The Siouxland Project documents that aggressive implementation of infection control measures can control an antibiotic-resistant bacteria."
After the outbreak, the Centers for Disease Control and Prevention (CDC) set up a program in 1997 to control the spread of the bacteria through hospitals, the authors explain in the May 10th issue of The New England Journal of Medicine.
The program consisted of screening patients in hospitals for vancomycin-resistant bacteria and then isolating infected patients from others. Other measures included rigorous hand washing by healthcare workers and the use of gloves and gowns whenever taking care of infected patients.
Before the outbreak in 1996, there were no cases of vancomycin-resistant enterococci (VRE) in the region. The overall prevalence of VRE peaked at 40 cases in 1997. That number dropped to 26 in 1998, and 9 cases in 1999 as a result of the control measures implemented by the program.
"Rather than trying to control VRE in one facility at a time, the entire healthcare community worked together to solve the problem," said Ostrowsky, from the CDC, in an interview with Reuters Health. "This partnership was unique. By working together, all the healthcare facilities were able to collaborate and control the transmission of VRE."
An important facet of the study was to assess which patients were at risk for contracting the resistant bacteria. The researchers found that patients who had been in the hospital for 3 days or had been on antibiotics for 2 weeks straight were more likely to be infected. This provided the doctors with a direct correlation between contracting the bacteria and treatment in a healthcare facility, underscoring the importance of implementing the control program in a wide variety of healthcare institutions.
The overuse of antibiotics has been implicated in the rise of antibiotic-resistant bacterial strains. However, the use of enhanced infection control practices is likely to significantly reduce outbreaks, Ostrowsky said.
"Expansion of efforts like the Siouxland Project to other regions has the potential to control antibiotic resistance, reduce infections and reduce costs, but most importantly, promote better outcomes for our patients," she added.
SOURCE: The New England Journal of Medicine 2001;344:1427-1433.