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Open Access Publications from the University of California

Vital signs: Estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities — United States

  • Author(s): Slayton, RB
  • Toth, D
  • Lee, BY
  • Tanner, W
  • Bartsch, SM
  • Khader, K
  • Wong, K
  • Brown, K
  • McKinnell, JA
  • Ray, W
  • Miller, LG
  • Rubin, M
  • Kim, DS
  • Adler, F
  • Cao, C
  • Avery, L
  • Stone, NTB
  • Kallen, A
  • Samore, M
  • Huang, SS
  • Fridkin, S
  • Jernigan, JA
  • et al.

© 2015, Department of Health and Human Services. All rights Reserved. Background: Treatments for health care–associated infections (HAIs) caused by antibiotic-resistant bacteria and Clostridium difficile are limited, and some patients have developed untreatable infections. Evidence-supported interventions are available, but coordinated approaches to interrupt the spread of HAIs could have a greater impact on reversing the increasing incidence of these infections than independent facility-based program efforts. Methods: Data from CDC’s National Healthcare Safety Network and Emerging Infections Program were analyzed to project the number of health care–associated infections from antibiotic-resistant bacteria or C. difficile both with and without a large scale national intervention that would include interrupting transmission and improved antibiotic stewardship. As an example, the impact of reducing transmission of one antibiotic-resistant infection (carbapenem-resistant Enterobacteriaceae [CRE]) on cumulative prevalence and number of HAI transmission events within interconnected groups of health care facilities was modeled using two distinct approaches, a large scale and a smaller scale health care network. Results: Immediate nationwide infection control and antibiotic stewardship interventions, over 5 years, could avert an estimated 619,000 HAIs resulting from CRE, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. difficile. Compared with independent efforts, a coordinated response to prevent CRE spread across a group of inter-connected health care facilities resulted in a cumulative 74% reduction in acquisitions over 5 years in a 10-facility network model, and 55% reduction over 15 years in a 102-facility network model. Conclusions: With effective action now, more than half a million antibiotic-resistant health care–associated infections could be prevented over 5 years. Models representing both large and small groups of interconnected health care facilities illustrate that a coordinated approach to interrupting transmission is more effective than historical independent facilitybased efforts. Implications for Public Health: Public health–led coordinated prevention approaches have the potential to more completely address the emergence and dissemination of these antibiotic-resistant organisms and C. difficile than independent facility–based efforts.

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