Case Study #1: Antimicrobial Resistance: A Historical Perspective On A Current Threat

Faculty

John E. McGowan Jr, MD
Professor of Epidemiology
Emory University Department of Epidemiology
The Rollins School of Public Health of Emory University

Robert C. Owens Jr, PharmD
Co-Director, Antimicrobial Stewardship Program
Maine Medical Center
Clinical Pharmacy Specialist, Infectious Diseases
Maine Medical Center
Clinical Assistant Professor
University of Vermont College of Medicine

Joseph S. Solomkin, MD
Professor of Surgery
Director of Research, Division of Trauma and Critical Care
University of Cincinnati College of Medicine

Needs Statement

Drug resistant organisms have increased across the globe and represent a major threat to the health of hospitalized patients. Overuse and improper use of certain antibiotic drug classes as well as failure to take infection control measures in hospitals has led to a major nosocomial infection problem in the United States. Antimicrobials account for upwards of 30% of hospital pharmacy budgets. It has been recognized for several decades that up to 50% of antimicrobial use is inappropriate, adding considerable cost to patient care. In addition to direct pharmacy acquisition costs, numerous reports suggest that inappropriate and unnecessary antimicrobial use leads to increased selection of resistant pathogens. Once antimicrobial resistance emerges, it can have a significant impact on patient morbidity and mortality, as well as increased health care costs.

The emergence of infections with multidrug-resistant gram-negative organisms, combined with a paucity of new drug development, has unfortunately led to the resurgent use of colistin, a polymyxin antimicrobial previously abandoned because of its high rates of nephrotoxicity and neurotoxicity. In 1998, the Institute of Medicine estimated that the annual cost of infections caused by antimicrobial-resistant bacteria was $4–$5 billion. Reducing the risk of health care acquired infection is one of seven 2004 National Patient Safety Goals set by JCAHO.

Evaluation of the literature suggests certain knowledge gaps may exist among hospital-based practitioners regarding the magnitude and growth of antibiotic resistance within hospitals, how to effectively limit resistance, how to treat patients infected with resistant pathogens, following appropriate infection control practices, and choosing appropriate treatment options for patients with resistance risk factors. A recent physician survey concluded that Although most physicians view antibiotic resistance as a serious national problem, perceptions about its local importance, its causes, and possible solutions vary more widely. Disparities in physician knowledge, beliefs, and attitudes may compromise efforts to improve antibiotic prescribing and infection control practices.

Objectives

1. Understand the magnitude and growth of antibiotic resistance to Staphylococcus aureus in the community and hospital settings;
2. Describe the spread of multiple drug resistant gram negative pathogens in hospitals;
3. Assess factors that promote the emergence and spread of resistance in the surgical setting;
4. Choose appropriate antibiotic strategies for surgical prophylaxis.

Accreditation

Medicine
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the University of Kentucky College of Medicine and CME Solutions. The University of Kentucky College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Kentucky College of Medicine designates this educational activity for a maximum of 0.50 AMA PRA Category 1 Credits™. Each physician should claim only those hours of credit actually spent in the educational activity.

The University of Kentucky College of Medicine presents this activity for educational purposes only. Participants are expected to utilize their own expertise and judgment while engaged in the practice of medicine. The content of the presentations is provided solely by presenters who have been selected for presentations because of recognized expertise in their field.

Activity Sponsorship