To the Editor:
Bacterial resistance is considered a public health problem worldwide, and efforts have been made to prevent and control this epidemic. The spread of resistant microorganisms is the major challenge that mobilizes national and international organs of epidemiologic surveillance and control.
, 2- Moody J.
- Cosgrove S.E.
- Olmsted R.
- Septimus E.
- Aureden K.
- Oriola S.
- et al.
Antimicrobial stewardship: a collaborative partnership between infection preventionists and health car epidemiologists.
Antimicrobial agent use and environmental factors of transmission have important roles in the emergence and spread of resistance mechanisms. Such measures as auditing antimicrobial use, hand hygiene, contact precautions, and in-service education do not always provide the expected contributions for resistance prevention and control.
3Antimicrobial stewardship—the state of the art in 2011: focus on outcome and methods.
It is important to stress that host-related factors and the selective pressure generated by antimicrobial agents, as well as easy movement of people, hinder the establishment of care.
In Brazil, according to the Ministry of Health, more than 70% of the bacteria that cause hospital infections are resistant to at least one antimicrobial agent commonly used in patient treatments.
Infected individuals have longer hospital stays and require treatment with drugs that may be less effective, more toxic, and more expensive and have a lower genetic profile. Bacterial resistance is facilitated by antibiotic use and the lack of infection control routines, leading to increased morbidity and mortality of individuals due to preventable diseases.
This brief study describes the profile of bacterial resistance and strategies for prevention and control in a teaching hospital in southern Brazil. The analysis of microbiological cultures of infections and colonization identified the hospital's microorganism profile. It was observed that hospitalizations due to infections increased the length of hospital stay by an average of 35 days. Analysis of data for the second half of 2011, with a total of 210 microorganisms identified, showed 48% of Staphylococcus spp resistant to methicillin, 26% of Pseudomonas spp resistant to carbapenem, 9% of Acinetobacter spp resistant to carbapenem, 7% of Klebsiela spp resistant to amikacin, and 12% of the CESP group resistant to amikacin. No resistance to polymyxin was noted.
Once these indicators were established, guidelines for contact precautions were reinforced. These precautions are ideally performed in private rooms with specific routines to reduce cross-transmission and management of infected patients at the bedside and on transport, provide guidance to family members and visitors, and provide alcoholic chlorhexidine at the bedside. To identify these patients, illustrative plates are placed on the doors of their rooms, listing routine use of materials and equipment specific for each type of precaution, as well as color charts according to each routine. An electronic surveillance system containing information on the colonized/infected patients helps maintain control of these measures. In this context, it is necessary to establish educational activities with the teams regarding the use of personal protective equipment, as well as hand hygiene of professionals and management of catheters and care protocols.
The efforts of all health professionals are essential to the control of infections related to health services, and their co-participation will favor the main outcome of minimizing bacterial resistance. Success is related to an approach that addresses the individual practice. Furthermore, this understanding confirms that the health professionals and institutions should abandon the simplistic idea that the infection control and transmission of nosocomial pathogens in health care facilities is the sole responsibility of Infection Control Committee members, and understand that professionals must actually be part of the process as members, and co-responsible for this process.
References
National Agency of Sanitary Surveillance, Ministry of Health of Brazil. Measures for identification, prevention and control of infections related to health care by multiresistant microorganisms. Brasília: ANVISA; 2010. http://portal.anvisa.gov.br/wps/wcm/connect/6c8f7b8047457811857ed53fbc4c6735/nota25-10-2010.pdf?MOD=AJPERES. Accessed October 2, 2012.
- Moody J.
- Cosgrove S.E.
- Olmsted R.
- Septimus E.
- Aureden K.
- Oriola S.
- et al.
Antimicrobial stewardship: a collaborative partnership between infection preventionists and health car epidemiologists.
Am J Infect Control. 2012; 40: 94-95Antimicrobial stewardship—the state of the art in 2011: focus on outcome and methods.
Infect Control Hosp Epidemiol. 2012; 33: 331-337
Article info
Publication history
Published online: October 11, 2012
Footnotes
Conflict of interest: None to report.
Copyright
© 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
