Establishing “rigorous infection-control procedures” remain the main tool to reign in these lethal outbreaks (NEJM 2012; 367: 2168-70).
While that message has been said before, the referenced article concisely discusses issues regarding multidrug-resistant gram-negative rods (MDR-GNRs) which are now much “more menacing” than methicillin-resistant Staphylococcus aureus (MRSA). The reason: there are no effective drugs available to treat some life-threatening MDR-GNR infections.
With resistance to cephalosporins increasing, clinicians have turned to carbapenems; as a consequence, resistance is emerging to these agents as well. Multidrug-resistant organisms (MDROs) are increasing; in addition, resistance that develops in one place of the world can quickly spread as shown by the MDR-GNRs with the New Delhi metallo-beta-lactamase 1.
- MDROs are transmitted mainly on the hands of caregivers. The most effective aspect of “rigorous infection-control procedures” remains hand washing.
- Some infections survive for prolonged periods on surfaces. For example, during an NIH outbreak of a MDR-GNR Klebsiella pneumoniae, klebsiella survived on a ventilator that had been cleaned three times with two different disinfectants.
- Antimicrobial stewardship is an important aspect of decreasing resistance. This includes sending cultures prior to antibiotics to tailor regimens, specifying the indication, documenting the expected duration of treatment, and assessing at 72 hours whether an ongoing antibiotic course is needed.
- If we adhere to established practices, infections due to invasive devices which are the source of most ICU infections can be minimized. For example, incorporating evidence-based “bundles” of care have been effective in reducing central line infections.
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