Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply, causing more harm. This problem is one of the most pressing public health threats currently and affects the ability to effectively treat disease.
Persons who develop infections that are resistant to antibiotics have increased risk of hospitalization and transfer to an intensive care unit, higher hospital costs, longer length of stay in the hospital, and higher risk of death.
In addition, antibiotics can also eliminate “good” bacteria from the body, increasing the risk for developing Clostridium difficile infection, a gastrointestinal illness.
Antibiotic resistance is not just a problem for the person with the infection; drug-resistant bacteria are able to spread and cause illness in others as well. Bacteria that are resistant to several types of antibiotics, or multidrug-resistant organisms require treatment with other medicines that may be less effective, more toxic, and more expensive.
In hospitals, an estimated 50% of antibiotic use is inappropriate or unnecessary. Some hospitals and long-term care facilities have begun to implement antibiotic stewardship interventions or programs to improve their antibiotic prescribing policies and practices. These programs have been proven to cut costs, reduce Clostridium difficile infections, and decrease the use of unnecessary antibiotics.
Preventing the Spread of Drug Resistance
There are several things healthcare providers can do to prevent the spread of drug resistance in a healthcare facility, including:
- Choose antibiotics wisely to reduce unnecessary antibiotic use.
- Only prescribe antibiotics when they will be beneficial to the patient (and not just when the patient asks for one).
- Target the likely pathogen as specifically as possible.
- Avoid overlaps in antibiotic prescription – it is usually unnecessary to give two antibiotics to treat the same bacteria.
- Never treat viruses (like the common cold or influenza) with antibiotics.
- Start or expand an antibiotic stewardship program in the facility.
- Assure that all medical providers are knowledgeable about appropriate antibiotic use, antibiotic resistance, and adverse effects.
- Be familiar with resistance trends in your region.
There are also several things patients can do to prevent the spread of drug resistance in their community, including:
- Talk to your healthcare provider about antibiotic resistance. Trust that he/she will give you an antibiotic only when you need it. Every illness does not require an antibiotic.
- Examples of illnesses that do NOT require an antibiotic:
- Colds or flu
- Most coughs and bronchitis
- Sore throats not caused by strep
- Runny noses
- When prescribed an antibiotic:
- Take it exactly as the doctor tells you. Complete the prescribed course even if you are feeling better. If you stop taking the drug too soon, some bacteria may survive, and you can get sick again.
- Do not save some of your antibiotic for the next time you get sick.
- Do not take an antibiotic that has been prescribed for someone else. The drug may not be appropriate for your illness and may delay correct treatment.
Tools and Resources
- General resources
- Other resources
- Antibiotic Resistant Threats in the United States, 2013 (CDC) - report that highlights 17 antibiotic-resistant bacteria and fungi that pose urgent, serious, or concerning threats to human health in the United States
- CDC antibiotic/antimicrobial resistance website – contains fact sheets, information on diseases/pathogens associated with drug resistance, education campaigns, and other relevant information
- CDC Implementation Resources – includes checklist for core elements of hospital antibiotic stewardship programs and assessment tools for appropriateness of antibiotic use
- CDC Vital Signs report (March 2014) - Antibiotic Prescriptions in Hospitals: Proceed with Caution
- Information on antibiotic prescribing practices in hospitals and ways to improve these practices to prevent allergic reactions, drug-resistant infections, and Clostridium difficile diarrhea.
- MMWR March 4, 2014: science behind the CDC Vital Signs report on improving antibiotic prescription practices for hospitalized patients
- Eastern Virginia Medical School (EVMS) - educational resources for healthcare consumers about antibiotic resistance
- Nighmare Bacteria: The Threat of Antibiotic Resistance (video)
- Nightmare Bacteria: The Discovery of Penicillin & Emergence of MRSA (video)
- Nightmare Bacteria: Tracking the Patterns (video)
- "Danger Ahead: The Rise in Antibiotic Resistance" (article)
- Get Smart – national antibiotic resistance awareness campaign led by the Centers for Disease Control and Prevention.
- Campaign aims to:
- Promote adherence to appropriate prescribing guidelines among healthcare providers
- Decrease demand for antibiotics for viral upper respiratory infections
- Increase adherence to prescribed antibiotics for upper respiratory infections
- Get Smart for Healthcare - resources to promote antibiotic stewardship in inpatient healthcare settings
- Get Smart Virginia - local antibiotic resistance awareness campaign (2003-2011) for the state of Virginia led by the Medical Society of Virginia Foundation (MSVF) in partnership with the Virginia Department of Health (VDH)
- Facility-specific resources
- For assisted living facilities and nursing homes
- Antibiotic Use in Long-Term Care Facilities (fact sheet)
- CDC 12 Steps to Prevent Antimicrobial Resistance Among Long-Term Care Residents
- Drug Resistance and Antibiotic Stewardship FAQ
- Loeb M, Bentley DW, Bradley S, Crossley K, Garibaldi R, Gantz N, McGeer A, Muder RR, Mylotte J, Nicolle LE, Nurse B, Paton S, Simor AE, Smith P, Strausbaugh L. Development of Minimum Criteria for the Initiation of Antibiotics in Residents of Long-Term–Care Facilities: Results of a Consensus Conference. Infection Control and Hospital Epidemiology 2001;22:120–124.
- SHEA Position Papers