The war against overuse of antibiotics and the resulting resistant infections is constantly being fought at the VA.
Sometimes battles are won – such as a successful program that decreased rates of healthcare associated MRSA infections 67% – and sometimes they are not. A recent study of antibiotic use in VA showed a 102% increase in the use of carbapenems, often the last treatment option for severe infections with multi-drug resistant pathogens) between 2005 and 2009.
“It’s never easy to find a solution to the question of why antibiotic resistance exists,” says Gary A. Roselle, MD, national director Infectious Diseases Program, VA Central Office, Washington, and chief, Medical Service, Cincinnati VA Medical Center, and professor of medicine in the Department of Internal Medicine, Division of Infectious Diseases, at the University of Cincinnati College of Medicine. “From the very early days of penicillin and vancomycin, whenever antibiotics have been used, resistance develops.” He points out that with improvements in medical care, especially in intensive care, the use of antibiotics has grown and resistance continues.
“This is happening globally – in the private sector and the military,” adds Allison A. Kelly, MD, MSOH, infectious diseases staff physician, Infectious Diseases Program Office, Washington, and assistant professor of medicine, Department of Internal Medicine, Division of Infectious Diseases, at the University of Cincinnati College of Medicine. “It’s reflective of the nature of bacteria building resistance and having fewer options to treat those infections.”
But the campaign continues. For example, the successful “MRSA” bundle program is being extended to other pathogens, according to Roselle. The program was implemented in 2007 in acute care VA hospitals nationwide. The “bundle,” or set of best practices, included universal nasal surveillance for MRSA, contact precautions for patients colonized or infected with MRSA, hand hygiene and culture change that made infection control the responsibility of everyone who had contact with patients.
Roselle said that VA is looking at Clostridium difficile for a similar approach, noting, “Beta test sites are now at work, and, once we see a protocol in proper order, it will be expanded across the country,” Roselle shares.
VA also has started a generalized antimicrobial stewardship program, one that is not necessarily organism-specific, he added.
“We already have had three educational conferences, starting in May 2010,” said Roselle, adding that an Antimicrobial Stewardship Task Force was chartered, and its sub-groups have already been meeting to look at other components of a national program. Plans for another national conference – “Antimicrobial Stewardship in VA” – are also moving forward.
“We began by looking at individual bacteria, are moving out to more and more antibiotic-resistant bacteria, and then, to a larger extent, we’ll look to the general situation in VA. So, it’s a multi-pronged approach,” Roselle explained.
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