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New Hospital Initiatives in Fighting Resistance

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Antibiotic Policies: Fighting Resistance
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Summary

The fight against the emergence and spread of antibiotic resistant organisms in hospitals demands a wide-ranging and comprehensive strategy of attack. Although a multifaceted approach is required, the following discussion will be restricted to the translation of new molecular techniques into diagnostic tests, and initiatives to optimize antibiotic prescribing in hospitals. An ideal rapid test would determine categorically whether a pathogen is present or not in a clinical sample, and if so, the identification and antibiotic susceptibility, all within 1–2 hours. Widespread use of such tests, and their translation into portable “near patient tests,” will undoubtedly have significant consequences regarding patient management and control of antibiotic resistance. In the wider hospital setting, developments in information technology and new applications of management, organization, and service delivery must be adopted to optimize antibiotic prescribing. By combining timely diagnostics with the larger-scale hospital systems for the delivery of care, we may start to win the battle against antibiotic resistance.

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References

  • Agranoff, D., A. Stich, et al. (2005) Proteomic fingerprinting for the diagnosis of human African trypanosomiasis. Trends Parasitol 21(4):154–7.

    Article  CAS  PubMed  Google Scholar 

  • Anon (2003) Winning Ways: Working together to reduce healthcare associated infection in England. Report of the Chief Medical Officer, Department of Health.

    Google Scholar 

  • Anon (2004) Improving patient care by reducing the risk of hospital acquired infection: A progress report. U.K. National Audit Office.

    Google Scholar 

  • Belanger, S. D., M. Boissinot, et al. (2003) Rapid detection of Clostridium difficile in feces by real-time PCR. J Clin Microbiol 41(2):730–4.

    Article  CAS  PubMed  Google Scholar 

  • Bergeron M.G. and M.Ouellette (1998) Minireview, Preventing Antibiotic Resistance through Rapid Genotypic Identification of Bacteria and of Their Antibiotic Resistance Genes in the Clinical Microbiology Laboratory. J chin Micro 36(8):2169-72.

    CAS  Google Scholar 

  • Boissinot, M. and M. G. Bergeron (2002) Toward rapid real-time molecular diagnostic to guide smart use of antimicrobials. Curr Opin Microbiol 5(5):478–82.

    Article  PubMed  Google Scholar 

  • Bryant, P. A., D. Venter, et al. (2004) Chips with everything: DNA microarrays in infectious diseases. Lancet Infect Dis 4(2):100–11.

    Article  CAS  PubMed  Google Scholar 

  • Call, D. R., M. K. Bakko, et al. (2003) Identifying antimicrobial resistance genes with DNA microarrays. Antimicrob Agents Chemother 47(10):3290–5.

    Article  CAS  PubMed  Google Scholar 

  • Classen, D. C., R. S. Evans, et al. (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326(5):281–6.

    Article  CAS  PubMed  Google Scholar 

  • Cooker, F. J., A.H. Holmes (2007) The missing care bundle: antibiotic prescribing in hospitals, Int J Antimicrob Agents doi: 10.1016/j.ijantimicag.2007.03.003.

    Google Scholar 

  • Cooper, B. S., S. P. Stone, et al. (2003) Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: A review of the literature with epidemiological and economic modelling. Health Technol Assess 7(39):1–194.

    CAS  PubMed  Google Scholar 

  • Corona, A., G. Bertolini, et al. (2003) Variability of treatment duration for bacteraemia in the critically ill: A multinational survey. J Antimicrob Chemother 52(5):849–52.

    Article  CAS  PubMed  Google Scholar 

  • Coyne, S. R., P. D. Craw, et al. (2004) Comparative analysis of the Schleicher and Schuell IsoCode Stix DNA isolation device and the Qiagen QIAamp DNA Mini Kit. J Clin Microbiol 42(10):4859–62.

    Article  CAS  PubMed  Google Scholar 

  • Davey, P., E. Brown, et al. (2006) Systematic review of antimicrobial drug prescribing in hospitals. Emerg Infect Dis 12(2):211–6.

    PubMed  Google Scholar 

  • Dean, B., W. Lawson, et al. (2002) The use of serial point prevalence studies to investigate antiinfective prescribing. Int J Pharm Pract 10: 121–5.

    Google Scholar 

  • Diep, B. A., S. R. Gill, et al. (2006) Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus. Lancet 367:731–9.

    Article  CAS  PubMed  Google Scholar 

  • Edwards, N., M. J. Kornacki, et al. (2002) Unhappy doctors: What are the causes and what can be done? BMJ 324:835–8.

    Article  PubMed  Google Scholar 

  • Espy, M. J., J. R. Uhl, et al. (2006) Real-time PCR in clinical microbiology: Applications for routine laboratory testing. Clin Microbiol Rev 19:165–256.

    Article  CAS  PubMed  Google Scholar 

  • Evans, R. S., S. L. Pestotnik, et al. (1998) A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med 338:232–8.

    Article  CAS  PubMed  Google Scholar 

  • Fleischmann, R. D., M. D. Adams, et al. (1995) Whole-genome random sequencing and assembly of Haemophilus influenzae Rd. Science 269:496–512.

    Article  CAS  PubMed  Google Scholar 

  • Foster, K. R. and H. Grundmann (2006) Do we need to put society first? The potential for tragedy in antimicrobial resistance. PLoS Med 3(2): e29.

    Article  PubMed  Google Scholar 

  • Goldmann, D. A., R. A. Weinstein, et al. (1996) Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals. A challenge to hospital leadership. JAMA 275: 234–40.

    Article  CAS  PubMed  Google Scholar 

  • Hackett, S. J., M. Guiver, et al. (2002) Meningococcal bacterial DNA load at presentation correlates with disease severity. Arch Dis Child 86: 44–6.

    Article  CAS  PubMed  Google Scholar 

  • Hardy, K. J., B. A. Oppenheim, et al. (2006) Use of variations in staphylococcal interspersed repeat units for molecular typing of methicillin-resistant Staphylococcus aureus strains. J Clin Microbiol 44: 271–3.

    Article  CAS  PubMed  Google Scholar 

  • Holland, C. A. and F. L. Kiechle (2005) Point-of-care molecular diagnostic systems—Past, present and future. Curr Opin Microbiol 8: 504–9.

    Article  PubMed  Google Scholar 

  • Holmes, A. (2006) Organisational change for infection protection. Developing an organisational model for infection control at Hammersmith Hospitals trust. Health Service Journal 8: 19–22, http://www.publicservice.co.uk/pdf/health/issue8/H8%20Dr%20Alison%20Holmes%20ATL.pdf

  • Huletsky, A., R. Giroux, et al. (2004) New real-time PCR assay for rapid detection of methicillin-resistant Staphylococcus aureus directly from specimens containing a mixture of staphylococci. J Clin Microbiol 42: 1875–84.

    Article  CAS  PubMed  Google Scholar 

  • Huletsky, A., P. Lebel, et al. (2005) Identification of methicillin-resistant Staphylococcus aureus carriage in less than 1 hour during a hospital surveillance program. Clin Infect Dis 40: 976–81.

    Article  PubMed  Google Scholar 

  • Kaplan, R. D.P. Norton (1996) The Balanced Scorecard: Translating Strategy into Action. Harvard Business School Press.

    Google Scholar 

  • Knox, K., W. Lawson, et al. (2003) Multidisciplinary antimicrobial management and the role of the infectious diseases pharmacist—A UK perspective. J Hosp Infect 53: 85–90.

    Article  CAS  PubMed  Google Scholar 

  • Knox, K. L., Lawson, A. Holmes (2004) Multidisciplinary Antimicrobial Management Teams and the Role of the Pharmacist in Management of Infection.

    Google Scholar 

  • Kuroda, M., T. Ohta, et al. (2001) Whole genome sequencing of meticillin-resistant Staphylococcus aureus. Lancet 357: 1225–40.

    Article  CAS  PubMed  Google Scholar 

  • Kusunoki, S., T. Ezaki, et al. (1991) Application of colorimetric microdilution plate hybridization for rapid genetic identification of 22 Mycobacterium species. J Clin Microbiol 29: 1596–603.

    CAS  PubMed  Google Scholar 

  • Lambert, H. P. (1999) Don’t keep taking the tablets? Lancet 354: 943–5.

    Article  CAS  PubMed  Google Scholar 

  • Lapierre, P., A. Huletsky, et al. (2003) Real-time PCR assay for detection of fluoroquinolone resistance associated with grlA mutations in Staphylococcus aureus. J Clin Microbiol 41: 3246–51.

    Article  CAS  PubMed  Google Scholar 

  • Maiden, M. C., J. A. Bygraves, et al. (1998) Multilocus sequence typing: A portable approach to the identification of clones within populations of pathogenic microorganisms. Proc Natl Acad Sci USA 95: 3140–5.

    Article  CAS  PubMed  Google Scholar 

  • Morozumi, M., E. Nakayama, et al. (2006) Simultaneous detection of pathogens in clinical samples from patients with community-acquired pneumonia by real-time PCR with pathogen-specific molecular beacon probes. J Clin Microbiol 44: 1440–6.

    Article  CAS  PubMed  Google Scholar 

  • Mortimer, P. and C. Arnold (2001) FAFLP: last word in microbial genotyping? J Med Microbiol 50: 393–5.

    CAS  PubMed  Google Scholar 

  • Nikkari, S., I. J. McLaughlin, et al. (2001) Does blood of healthy subjects contain bacterial ribosomal DNA? J Clin Microbiol 39: 1956–9.

    Article  CAS  PubMed  Google Scholar 

  • Peters, R. P., T. Mohammadi, et al. (2004a) Detection of bacterial DNA in blood samples from febrile patients: Underestimated infection or emerging contamination? FEMS Immunol Med Microbiol 42: 249–53.

    Article  CAS  PubMed  Google Scholar 

  • Peters, R. P., M. A. van Agtmael, et al. (2004b) New developments in the diagnosis of bloodstream infections. Lancet Infect Dis 4: 751–60.

    Article  CAS  PubMed  Google Scholar 

  • Peters, R. P., P. H. Savelkoul, et al. (2006) Faster identification of pathogens in positive blood cultures by fluorescence in situ hybridization in routine practice. J Clin Microbiol 44: 119–23.

    Article  PubMed  Google Scholar 

  • Picard, F. J. and M. G. Bergeron (2002) Rapid molecular theranostics in infectious diseases. Drug Discov Today 7: 1092–101.

    Article  CAS  PubMed  Google Scholar 

  • Pulcini, C., C. Pradier, et al. (2006) Factors associated with adherence to infectious diseases advice in two intensive care units. J Antimicrob Chemother 57: 546–50.

    Article  CAS  PubMed  Google Scholar 

  • Relman, D. A. (2003) Shedding light on microbial detection. N Engl J Med 349: 2162–3.

    Article  CAS  PubMed  Google Scholar 

  • Rider, T. H., M. S. Petrovick, et al. (2003) A B cell-based sensor for rapid identification of pathogens. Science 301: 213–5.

    Article  CAS  PubMed  Google Scholar 

  • Roger, M., P. St-Antoine, et al. (2001) Vancomycin-resistant enterococci in health care facilities. N Engl J Med 345: 768–9.

    Article  CAS  PubMed  Google Scholar 

  • Seaton, R. A., D. Nathwani, et al. (1999) Clinical record keeping in patients receiving antibiotics in hospital. Health Bull (Edinb) 57: 128–33.

    CAS  Google Scholar 

  • Silversin, J. and M.J. kornacki (2000) Leading Physicians through Change: How to Achieve and Sustain Results. American College of Physician Executives.

    Google Scholar 

  • Sintchenko, V., J. R. Iredell, et al. (2005) Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care. J Am Med Inform Assoc 12: 398–402.

    Article  PubMed  Google Scholar 

  • Stefanelli, P., A. Carattoli, et al. (2003) Prediction of decreased susceptibility to penicillin of Neisseria meningitidis strains by real-time PCR. J Clin Microbiol 41: 4666–70.

    Article  CAS  PubMed  Google Scholar 

  • Tan, J. A., V. N. Naik, et al. (2006) Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections. Qual Saf Health Care 15: 32–8.

    Article  CAS  PubMed  Google Scholar 

  • Uhl, J. R., S. C. Adamson, et al. (2003) Comparison of LightCycler PCR, rapid antigen immunoassay, and culture for detection of group A streptococci from throat swabs. J Clin Microbiol 41: 242–9.

    Article  CAS  PubMed  Google Scholar 

  • Uhl, J. R., E. A. Vetter, et al. (2005) Use of the Roche LightCycler Strep B assay for detection of group B streptococcus from vaginal and rectal swabs. J Clin Microbiol 43: 4046–51.

    Article  CAS  PubMed  Google Scholar 

  • Wolk, D., S. Mitchell, et al. (2001) Principles of molecular microbiology testing methods. Infect Dis Clin North Am 15: 1157–204.

    Article  CAS  PubMed  Google Scholar 

  • Yang, S. and R. E. Rothman (2004) PCR-based diagnostics for infectious diseases: Uses, limitations, and future applications in acute-care settings. Lancet Infect Dis 4: 337–48.

    Article  CAS  PubMed  Google Scholar 

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Cooke, F., Holmes, A. (2008). New Hospital Initiatives in Fighting Resistance. In: Gould, I.M., van der Meer, J.W. (eds) Antibiotic Policies: Fighting Resistance. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-70841-6_7

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