Antibiotic resistance causing issues for surgical patients

While looking over a patient’s lab results, Lisa Waldowski, MS, APRN, CIC, noticed that the patient had methicillin-resistant staphylococcus aureus. It was obvious to Ms. Waldowski, an infection preventionist in a hospital at the time, that the standard antibiotic wouldn’t work for the patient, who was being prepped in the operation room (OR). She immediately called the OR and told the operating team not to administer the antibiotic as ordered but to obtain one that would be effective for the specific organisms that this patient had.

“When you have a drug-resistant organism, using a broad-spectrum antibiotic that the organism is not sensitive to is like throwing water at it. You’re not treating anything,” according to Ms. Waldowski, who now serves as The Joint Commission’s infection control specialist. In this role, Ms. Waldowski advises Joint Commission surveyors with interpretations of and education in infection control findings; she also responds to challenging questions, complaints, and potential threats to life/patient safety infection control-related events.

Inappropriate use

The Centers for Disease Control and Prevention (CDC) cites studies indicating that 30 percent to 50 percent of prescribed antibiotics in hospitals are administered in settings where an antibiotic is unnecessary or is ineffective against the pathogenic organisms. Increased and inappropriate antibiotic use leads to increased risks of antibiotic resistance, as well as contributing to clostridium difficile (C. difficile) infections. The CDC estimates that antibiotic-resistant bacteria cause 23,000 deaths and 2 million illnesses annually in the U.S.1

According to a report from the Infectious Diseases Society of America and the Society for Healthcare Epidemiology, antibiotics were prescribed incorrectly in 50 percent of the cases studied—whether because other treatment options would have been more effective or the prescribed dosing or duration was improper.2 In particular, prolonged surgical prophylaxis leads to excessive antibiotic use with its attendant complications. Most research shows that preoperative prophylaxis reduces surgical site infections by 50 percent or more, but continuing the antibiotic after the operation is over does not improve efficacy and actually increases antibiotic complications.3 Similarly, recent research shows that for intra-abdominal infections in which an effective source control has been achieved either by the surgeon or an interventional radiologist a short course of antibiotics (four to five days) is as effective as eight to 10 day dosages.4

Efforts to improve patient safety

The practice of safely and judiciously prescribing antibiotics has become a patient safety issue—one for which President Barack Obama’s Administration has created a national action plan. The goals of the proposal include the following:

  • Slow the growth of resistant bacteria and the spread of resistant infections
  • Advance development and use of diagnostic tests to identify and characterize resistant bacteria
  • Develop new antibiotics or other vaccines5

“When you have patients who have already been on antibiotics, or who have been using antibiotics inappropriately, there is a potential for development of multiple drug-resistant organisms and severe diarrheal infections that include C. difficile,” Ms. Waldowski says. “This happens because you aren’t just wiping out what you’re intending to, but also unfortunately wiping out normal flora that is needed and present in the gut and within parts of our bodies. You can cause harm when you’re not using antibiotics appropriately.”

In a surgical setting, Waldowski suggests following evidence-based guidelines when prescribing antibiotic prophylaxis and confirming that the right patient is being given the right antibiotic, at the right dose, and for the right amount of time. In addition, staff in hospitals and ambulatory surgery centers can help to improve antibiotic use and protect their surgical patients by sharing necessary antibiotic information when there is a transfer of care and implementing antimicrobial stewardship programs to provide focus for each person’s role in the appropriate administration of an antibiotic.

Providers have a resource to help with educating patients about antibiotics. The Joint Commission’s Speak Up campaign focuses on the do’s and don’ts of antibiotics, including a table that lists the illnesses that may require an antibiotic. These materials are available online.

Disclaimer

The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily represent the official views of The Joint Commission or the American College of Surgeons.


References

  1. Slayton RB, Toth D, Lee BY. Vital signs: Estimated effects of a coordinated approach for action to reduce antibiotic-resistant infections in health care facilities—United States. Morbidity and Mortality Weekly Report. 2015;64(30):826-831.
  2. Centers for Disease Control and Prevention. Antibiotic/antimicrobial resistance. Available at: www.cdc.gov/drugresistance/about.html. Accessed November 20, 2015.
  3. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect. 2013;14(1):73-156.
  4. Sawyer RG, Claridge JA, Nathens AB, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372(21):1996-2005.
  5. The White House. National action plan for combating antibiotic-resistant bacteria. Available at: www.whitehouse.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Accessed November 20, 2015.

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