Risk Factors for the Spread of Antibiotic-Resistant Bacteria

Abstract

The emergence of antibiotic resistance is primarily due to excessive and often unnecessary use of antibiotics in humans and animals. Risk factors for the spread of resistant bacteria in hospitals and the community can be summarised as over-crowding, lapses in hygiene or poor infection control practices. Increasing antibiotic resistance in bacteria has been exacerbated by the slow pace in developing newer antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and multiresistant Gram-negative bacteria are spread primarily by direct or indirect person-to-person contact. Independent risk factors for MRSA include the use of broad spectrum antibiotics, the presence of decubitus ulcers and prosthetic devices while those for VRE include prolonged hospitalisation and treatment with glycopeptides or broad spectrum antibiotics. For the spread of resistant Gram-negative bacteria risk factors include urinary catheterisation, excessive use of antibiotics and contamination of humidifiers and nebulisers. The spread of penicillin-resistant pneumococci (PRP) and drug-resistant and multidrug-resistant tuberculosis (MDRTb) is due to airborne transmission. Risk factors for the spread of PRP include overcrowding, tracheostomies and excessive use of penicillins for viral respiratory infections; for MDRTb they include poor compliance, convergence of immunosuppressed patients, delayed diagnosis or treatment, and poor or inadequate ventilation and isolation facilities. Recent developments in the genomic mapping of many bacteria and advances in combinatorial chemistry promise to usher in a new era of antibiotic development. While this may result in our regaining some of the ground lost to resistant bacteria, there will still be a continuing need to minimise the spread of antibiotic resistance through the rational use of antibiotic agents and stringent infection control practice.

Beneficial effects of implementing guidelines on microbiology and costs of infected diabetic foot ulcers

“…Nevertheless, we cannot attribute those changes only to the implementation of guidelines. Indeed, the French National Observatory for Epidemiology of Bacterial Resistance to Antimicrobials and the European Antimicrobial Resistance Surveillance System reported a decrease in the prevalence of MRSA in France [22,23], and MRSA strains responsible for bacteraemia decreased from 33% in 2001 to 26% in 2007. This trend could be explained by a change in the major epidemic clone of MRSA detected in French hospitals (replacing the Iberic clone with the pandemic clone V) [24,25].…”

Preemptive Isolation to Prevent Methicillin-Resistant Staphylococcus aureus Cross-Transmission in Diabetic Foot

“…Therefore, although the impact of MRSA on the outcome of the ulcer remains debatable (5,6), the prevention of MRSA cross-transmission should be a priority in such units (6 -8). The implementation of strict isolation precautions is highly recommended (9 -12) because MRSA is mainly transmitted through the hands of transiently colonized health care personnel (9,13,14). Our objective was to assess the efficiency of preemptive isolation procedures implemented in a diabetic foot unit to prevent MRSA cross-transmission.…”

“Isolation and Characterization of Lactose and Non- Lactose Fermenting Bacteria From Tertiary Care Hospital and Their Antimicrobial Susceptibility Test”

“…Risk factors for the spread of PRP include overcrowding, tracheostomies and excessive use of penicillins for viral respiratory infections; for MDRTb they include poor compliance, the convergence of immunosuppressed patients, delayed diagnosis or treatment, and poor or inadequate ventilation and isolation facilities [3].…”