Issue: June 2008
June 01, 2008
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Thorough patient assessments can help determine infection risk

To reduce the spread of antibiotic-resistant infections in hospitals, patients should be assessed for risk factors during admission.

Issue: June 2008
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BARCELONA, Spain – Patients should be assessed at the time of hospital admission to determine their risk for acquiring an infection caused by antibiotic-resistant bacteria, according to the results of a new Italian study.

The results of the study, presented at the 18th European Congress of Clinical Microbiology and Infectious Diseases, held here in April, also demonstrated that more thorough patient assessments at the time of hospital admission may be associated with a reduced risk for infection transmission. Furthermore, improved assessments at hospital admission may have a beneficial effect on the selection of appropriate therapy for patients who require treatment.

Evelina Tacconelli, MD, assistant professor of infectious diseases at the Università Cattolica del Sacro Cuore in Rome, and one of the study’s researchers, spoke with Infectious Disease News about the results. Tacconelli said an assessment at hospital admission can help to easily identify patients who may be at the highest risk for developing an infection caused by antibiotic-resistant bacteria. “Patients at the highest risk for being admitted to the hospital with an infection caused by antibiotic-resistant bacteria were those aged 60 years or older; those with urinary catheters; those with severe underlying conditions, such as cancers or chronic renal failure and those with a history of antibiotic exposure within one month,” Tacconelli said.

  ECCMID 2008

Assessing patients

Tacconelli and her colleagues conducted a one-year cohort study assessing the prevalence of patients who developed infections from antibiotic-resistant bacteria within 72 hours of admission at an Italian hospital. The antibiotic-resistant bacteria that were assessed included methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta–lactamase (ESBL)-producing bacteria, ciprofloxacin-resistant Escherichia coli and multidrug-resistant gram-negative bacteria.

During the course of the year, infections caused by antibiotic-resistant bacteria were diagnosed in 398 patients — equivalent to seven cases per 1,000 hospital admissions.

Independent risk factors for antibiotic-resistant infections included urinary catheter, antibiotic therapy within 30 days and being aged older than 60 years. The presence of all risk factors was associated with a greater risk of infection.

Twenty-two percent of the isolates were ESBL-producing bacteria; 17% were MRSA; 10% were carbapenems-resistant Pseudomonas aeruginosa and 2% were VRE. Tacconelli said 94% of these were health care-associated infections and 6% were community-associated infections.

Overuse of antibiotics

Tacconelli said patients treated with antibiotics during the past 30 days were at an increased risk for developing an infection caused by an antibiotic-resistant bacteria. This finding may have important implications for public health.

“The use of antibiotics in the previous 30 days increased the risk of developing an infection caused by MDR bacteria nearly threefold,” Tacconelli said. “In particular, use of penicillin and quinolone antibiotics was the most significant risk factors for these infections.”

Tacconelli said it is important for physicians to be prudent when prescribing antibiotics to their patients. “Because antibiotic therapy is a risk factor for the acquisition of MDR bacteria infection not only in the hospitals but also in the community, as once again demonstrated by our study, physicians should sharpen their clinical judgment when choosing antibiotic therapy,” she said.

Tacconelli said a multifaceted approach may be needed to fight antibiotic resistance. “The reduction of antibiotic resistance outside the hospital requires a complex and multidisciplinary approach,” she said. “A stronger control in antibiotic use in the community and in long-term care facilities would definitely affect the prevalence of such infections. Inappropriate use of antibiotics in food animals – still in use in many countries – should be banned. Campaigns aimed to educate the public on the prudent use of antibiotics also are essential.” – by Jay Lewis

For more information:
  • Tacconelli E, Iannotti N, Venturiello S, et al. Infections due to antibiotic-resistant bacteria diagnosed at hospital admission: incidence and risk factors. Presented at: the 18th European Congress of Clinical Microbiology and Infectious Diseases; April 19-22, 2008; Barcelona, Spain.