Infection Prevention

Resistance to antibiotics was observed soon after these drugs were introduced into clinical medicine, but the phenomenon has increased in frequency and importance in recent years. Bacteria are highly adaptable and can develop resistance by mutation or by the acquisition of resistance genes from other organisms. The magnitude of the resistance problem varies by the specific antibiotic and pathogen (disease-causing organism). For example, despite years of exposure to penicillin, group A streptococci bacteria remain just as penicillin-susceptible as they ever were, but Staphylococcus aureus acquired a resistance to penicillin within a decade of its first use.

In general, pathogens acquired in the community are more susceptible to antibiotics than those acquired in the hospital. Furthermore, hospital-acquired bacteria are more likely to be resistant to multiple antibiotics. Unnecessary antibiotic use is a major factor in resistance development, so antibiotics are not prescribed when they can be of no benefit, as in viral infections. Lahey restricts the use of several of the most powerful antibiotics to infectious disease experts and other specialists, and we also monitor overall antibiotic use to ensure that it remains appropriate.

Particular pathogens that historically have shown antibiotic resistance:

• Staphylococcus aureus and coagulase negative staphylococci are not only penicillin-resistant but also appear to be 50 percent or more resistant to semi-synthetic penicillins such as oxacillin. Vancomycin is widely used to treat such S. aureus infections.
• Enterococcus faecium and Enterococcus faecalis have always been relatively resistant to antimicrobial agents. They have lately developed increasing resistance to vancomycin, otherwise a mainstay in their therapy. A new antibiotic, linezolid, is often used to treat vancomycin-resistant isolates, but resistance can develop to this agent as well.
• Streptococcus pneumoniae is a community-acquired pathogen that has increased in resistance to penicillin and other antibiotics within the past decade. When the organism causes meningitis, alternative antibiotics must be used until penicillin susceptibility can be determined.
• Klebsiella pneumoniae from some hospitals has acquired the ability to destroy the best available broad-spectrum cephalosporin antibiotics.
• Pseudomonas aeruginosa can all too easily acquire resistance to multiple antibiotics, particularly in patients with chronic infection and those who have had many prior antibiotic exposures.Pharmaceutical companies continue to develop new antimicrobial agents for problem pathogens, but in the last few years primary research has been focused elsewhere. Unfortunately, the bacteria remain just as active in developing resistance. In addition to encouraging the wise use of available antibiotics, Lahey physicians are investigating the use of new agents and studying how bacteria develop resistance to individual drugs. Antibiotic resistance is a problem that will never disappear and therefore requires constant attention.

What You, as a Patient, Can Do

Infections can occur after many types of medical procedures. This is particularly true if you are having surgery. There are several things you can do to avoid getting an infection in the hospital:

• Wash your hands carefully after handling any type of soiled material. This is especially important after using the bathroom.
• Do not be afraid to remind doctors and nurses about washing and/or disinfecting their hands before working with you.
• If you have an intravenous catheter or an open wound, keep the skin around the dressing clean and dry. Immediately tell your nurse if the dressing becomes loose or gets wet.
• If you have diabetes, be sure that you and your doctor discuss the best way to control your blood sugar before, during and after your hospital stay. High blood sugar noticeably increases the risk of infection.
• If you are overweight, losing weight will reduce the risk of infection following surgery.
• If you are a smoker, you should consider a smoking cessation program. This will reduce the chance of developing a lung infection while in the hospital and may also improve your healing abilities following surgery.
• Carefully follow your doctor’s instructions regarding breathing treatments and getting out of bed. Don’t be afraid to ask for help, advice or sufficient pain medications.
• If possible, ask your friends and relatives not to visit if they are feeling ill.
• Don’t be afraid to ask questions about your care so that you may fully understand your treatment plan and expected outcomes. Doing so will help you and your family and friends better facilitate your recovery. 

Antibiotic Resistance Issues

Infections that occur in the hospital setting are often due to bacteria that have acquired resistance to commonly used antibiotics. Two of the most common resistant bacteria are methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).

Commonly Asked Patient Questions

• Clostridium difficile (C. difficile)
• Methicillin-resistant Staphylococcus aureus (MRSA)

Fact Sheets about Hospital Associated Infections:

A group of the leading infection control and infectious disease societies of America have authored patient fact sheets to assist health care providers teach patients and families about infection prevention and control. These fact sheets are useful to help patients and families understand measures to prevent infection when devices such as ventilators, urinary catheters and central lines are necessary and provide education about hospital infections such as C. difficile or MRSA.

• Central Line-Associated Bloodstream Infections (CLABSI)
• MRSA (Methicillin-Resistant Staphylococcus aureus)
• Ventilator-Associated Pneumonia (VAP)