The role of infection control in curbing Carbapenem resistance

Abstract

Carbapenem resistant Gram-negative pathogens have become a threat to many countries in Western Pacific Region. These microorganisms are difficult to treat and pose challenges for control strategies. Much of the emergence and spread of carbapenem resistant Gram-negative pathogens can be contributed to the non-judicious use of broad-spectrum antibiotics and poor infection control. Once antimicrobial resistance emerges, it can have a significant impact on patient morbidity and mortality, as well as increased health care costs. Antimicrobial stewardship is a key component of a multifaceted approach to preventing the emergence of carbapenem resistant Gram-negative pathogens. Application of antimicrobial stewardship to resource-limited setting can be challenging. The antimicrobial stewardship program at Thammasat University Hospital, which has been associated with appropriateness of antibiotic use and improved treatment rates, decreased failure rates, and reduced healthcare-related costs, is an example of this multifaceted, multidisciplinary approach. The components of our antimicrobial stewardship program include continuous education, introduction of the antibiogram, antibiotic guideline, and antibiotic prescription forms with an antimicrobial stewardship team to continuously monitor the consumption of and audit the use of antibiotics with real-time, bed-side discussion with prescribing physicians. This antimicrobial stewardship program began in 2004 and appears to have been sustained over a 8-year period. Nevertheless, to sustain or even further improve these results, lasting and repeated efforts will be needed. Integrating infection control efforts into educational and antimicrobial stewardship programs is warranted. Active infection control program in resource-limited settings for carbapenem resistant Gram-negative pathogens may include modified active surveillance, contact isolation, cohorting patients with carbapenem resistant Gram-negative pathogens, 5 moment hand hygiene, environmental cleaning, as well as monitoring healthcare workers and providing prompt feedback. These strategies must be modified to fit the local setting, organizational culture, and infrastructure. Intensified efforts in infection control programs and antibiotic stewardship serve as key components for long-term success. Given the limited information of infection control for carbapenem resistant Gram-negative pathogens in resource-limited setting, additional well-designed studies are needed to explore various aspects of outcomes of antimicrobial stewardship and infection control in resource-limited settings.