R.Ph.s endorse CDC guide on resistant infections

December 11, 2006

With an estimated 90,000 deaths annually linked to hospital-acquired infections, preventing the spread of drug-resistant infections is a top priority for health-system pharmacists. A new guidance document from the Centers for Disease Control & Prevention, "Management of Multi-Resistant Organisms in Healthcare Settings," is getting good marks for providing tips on how to stem these infections.

Claudine El-Beyrouty, Pharm.D., advanced practice pharmacist in infectious diseases at Thomas Jefferson University Hospital in Philadelphia, said that certain sections of the CDC document, particularly in the area of antimicrobials, is very useful to pharmacists. "It's definitely an area that we are involved with, and it's nice to have a document with CDC recommendations that you could show an administrator."

El-Beyrouty noted that the CDC guidelines highlight different organisms for which pharmacists can target certain drugs, such as vancomycin. "It's good to have that information all in one place."

"They really are hospital epidemiology-based guidelines," said Todd Correll, Pharm.D., at the University of North Carolina Hospitals in Chapel Hill. He finds the CDC guidelines very helpful, "especially if you are a pharmacist who focuses on infection control and epidemiology, disease states, and containing and preventing the spread of multi-drug-resistant organisms [MDROs] in a health-care setting."

The CDC guidance provides pharmacists with a lot of useful background information about active surveillance control programs and the importance of good hand hygiene and the use of gloves, noted Correll. He added that his facility is incorporating some of the new CDC recommendations including looking at ICU-specific biograms that allows pharmacists to track trends that are associated with resistance based on what kind of anti-infectives are being used from a global standpoint.

What guidelines don't do, said Correll, is recommend particular agents or treatment strategies from an anti-microbial standpoint to prevent the occurrence of resistant organisms. "The guidelines focus completely on the epidemiology and infection control side."

The topic of drug-resistant infections has been getting a lot of attention in recent years due in part to a steep rise in the proportion of bacteria that are resistant to antibiotics. One bacterium that is particularly troublesome is Staphylococcus aureus, commonly referred to as "staph." According to CDC, in 1972 only 2% of these types of bacteria were drug resistant. Jump ahead to 2004, and 63% had become resistant to antibiotics that are commonly used to treat them. In addition, methicillin-resistant staph infection, or MRSA, is becoming an increasing problem for hospitals and healthcare facilities, including nursing homes and dialysis centers.

John Jernigan, a medical epidemiologist at the CDC division of healthcare quality promotion, said that resources must be made available for infection prevention and control. He added that these resources should include expert consultation, laboratory support, adherence monitoring, and data analysis. Among the intervention categories outlined in the CDC guidelines are: administrative measures and adherence monitoring, MDRO education, judicious antimicrobial use, surveillance, infection control, precautions to prevent transmission, environmental measures, and decolonization.

Jernigan noted that because institutions vary widely in their characteristics, an effective prevention program has to recognize the unique character of a particular facility. For instance, the infection-control needs of an ICU will differ from those of a nursing home.

But some industry experts believe that the CDC guidelines don't go far enough. Betsy McCaughey, Ph.D., chairman of the Committee to Reduce Infection Deaths, said that the CDC guidelines are disappointing. "More than 100 studies demonstrate that identifying the patients bringing dangerous bacteria into the hospital is the essential step in preventing drug-resistant infections." McCaughey contended that the CDC guidelines fail to recommend that hospitals test incoming patients for these bacteria.