Containing Unusual Resistance - Early, Aggressive Action Can Prevent Spread
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Posted: Friday, April 6, 2018 10:20 AM
ore than 23,000 Americans die each year from infections caused by germs resistant to antibiotics. While antibiotic resistance (AR) threats vary nationwide, AR has been found in every state. And unusual resistance germs, which are resistant to all or most antibiotics tested and are uncommon or carry special resistance genes, are constantly developing and spreading. Lab tests uncovered unusual resistance more than
200 times in 2017 in "nightmare bacteria" alone. With new resources nationwide, early and aggressive action-when even a single case is found-can keep germs with unusual resistance from spreading in health care facilities and causing hard-to-treat or even untreatable infections. For example, CDC estimates show that this aggressive approach could prevent 1,600 cases of CRE* in one state over three years. Health departments can lead the Containment Strategy and act swiftly with health care facilities and CDC at the first sign of unusual resistance.
State and local health departments can:
- Make sure all health care facilities know what state and local lab support is available and what isolates (pure samples of a germ) to send for testing. Develop a plan to respond rapidly to unusual genes and germs when they first occur.
- Assess the quality and consistency of infection control in health care facilities across the state. Help improve practices.
- Coordinate with affected health care facilities, the new AR Lab Network regional labs, and CDC for every case of unusual resistance. Investigations should include onsite infection control assessments and colonization screenings for people who might have been exposed. They could spread it to others. Continue until spread is controlled.
- Provide timely lab results and recommendations to affected health care facilities and providers. If the patient came from or was transferred to another facility, alert that facility
PROBLEM:Antibiotic-resistant germs can spread like wildfire.
Germs constantly develop resistance against new and older antibiotics. Antibiotic-resistant germs can cause difficult-to-treat or untreatable infections. Some types of antibiotic resistance are already widespread. Once antibiotic resistance spreads, it is harder to control-like a wildfire. Finding and responding to unusual resistance early, before it becomes common, can help stop its spread and protect people. New or rare types of antibiotic resistance can be easier to contain when found rapidly-like a spark or campfire.
UNUSUAL ANTIBIOTIC-RESISTANT GERMS
- Resistant to all or most antibiotics tested, making them hard to treat, and
- Uncommon in a geographic area or the US, or
- Have special genes that allow them to spread their resistance to other germs
Examples of unusual resistance: Vancomycin-resistant Staphylococcus aureus (VRSA), Candida auris, and certain types of "nightmare bacteria" such as carbapenem-resistant Enterobacteriaceae (CRE).
WHAT CAN BE DONE
THE FEDERAL GOVERNMENT IS :
- Monitoring resistance and sounding the alarm when threats emerge. CDC develops and provides new lab tests so health departments can quickly identify new threats.
- Improving identification through CDC's new AR Lab Network in all 50 states, 5 large cities, and Puerto Rico, including 7 regional labs and a national tuberculosis lab for specialty testing.
- Supporting prevention experts and programs in every state, and providing data and recommendations for local prevention and response.
- Testing innovative infection control and prevention strategies with health care and academic partners.
STATE AND LOCAL HEALTH DEPARTMENTS AND LABS CAN :
- Make sure all health care facilities know what state and local lab support is available and what isolates (pure samples of a germ) to send for testing. Develop a plan to respond rapidly to unusual genes and germs when they first appear.
- Assess the quality and consistency of infection control in health care facilities across the state, especially in facilities with high-risk patients and long stays. Help improve practices.
- Coordinate with affected health care facilities, the new AR Lab Network regional lab, and CDC for every case of unusual resistance. Investigations should include onsite infection control assessments to find spread. Consider colonization screenings. Continue until spread is controlled.
- Provide timely lab results and recommendations to affected health care facilities and providers. If the patient came from or was transferred to another facility, alert that facility.
THE FEDERAL GOVERNMENT IS :
- Monitoring resistance and sounding the alarm when threats emerge. CDC develops and provides new lab tests so health departments can quickly identify new threats.
- Improving identification through CDC's new AR Lab Network in all 50 states, 5 large cities, and Puerto Rico, including 7 regional labs and a national tuberculosis lab for specialty testing.
- Supporting prevention experts and programs in every state, and providing data and recommendations for local prevention and response.
- Testing innovative infection control and prevention strategies with health care and academic partners.
STATE AND LOCAL HEALTH DEPARTMENTS AND LABS CAN :
- Make sure all health care facilities know what state and local lab support is available and what isolates (pure samples of a germ) to send for testing. Develop a plan to respond rapidly to unusual genes and germs when they first appear.
- Assess the quality and consistency of infection control in health care facilities across the state, especially in facilities with high-risk patients and long stays. Help improve practices.
- Coordinate with affected health care facilities, the new AR Lab Network regional lab, and CDC for every case of unusual resistance. Investigations should include onsite infection control assessments to find spread. Consider colonization screenings. Continue until spread is controlled.
- Provide timely lab results and recommendations to affected health care facilities and providers. If the patient came from or was transferred to another facility, alert that facility.
HEALTH CARE FACILITIES CAN :
- Plan for unusual resistance arriving in your facility. Find resources: www.cdc.gov/hai/outbreaks/mdro
- Leadership: Work with the health department to stop spread of unusual resistance. Review and support infection control in the facility.
- Clinical labs: Know what isolates to send for testing. Establish protocols that immediately notify the health department, healthcare provider, and infection control staff of unusual resistance. Validate new tests to identify the latest threats. If needed, use isolates from www.cdc.gov/ARIsolateBank.
- Healthcare providers, epidemiologists, and infection control staff: Place patients with unusual resistance on contact precautions, assess and enhance infection control, and work with the health department to screen others. Communicate about status when patients are transferred. Continue infection control assessments and colonization screenings until spread is controlled. Ask about any recent travel or health care to identify at-risk patients.
EVERYONE CAN :
- Inform your healthcare provider if you recently received health care in another country or facility.
- Talk to your healthcare provider about preventing infections, taking good care of chronic conditions and getting recommended vaccines.
- Practice good hygiene, such as keeping hands clean with handwashing or alcohol-based hand rubs, and keep cuts clean until healed.
Find resources: www.cdc.gov/hai/outbreaks/mdro
For more information, please contact Telephone: 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 | Web: www.cdc.gov
Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Publication date: April 3, 2018
www.cdc.gov/vitalsigns/containing-unusual-resistance www.cdc.gov/mmwr