N.J. Experts Urge Prudent Antibiotic Use

A task force examining the expensive, sometimes deadly problem of bacteria increasingly becoming resistant to antibiotics says New Jersey hospitals must increase surveillance of these microbes and improve infection control practices.

A strategic plan from the task force, released Monday, also recommends better educating the public about the danger and standardizing testing to determine which antibiotics best kill specific microbes prevalent in a hospital or region, information that can guide doctors' choice of medication.

The 30-member task force of health experts, established in February 2005 by the state Department of Health & Senior Services, sets those four steps as goals, along with a fifth: calculating the economic impact of antimicrobial resistance in New Jersey and demonstrating the financial benefits of reducing the problem.

"It's all the right stuff that has to be done," said Aline Holmes, the New Jersey Hospital Association's head of clinical affairs.

Health Commissioner Dr. Fred M. Jacobs said despite current antibiotics losing their effectiveness, pharmaceutical companies are developing few new ones as they focus on more-lucrative drugs for chronic conditions.

"We are charged with preserving the effectiveness of the antibiotics we have because of the limited prospect of new antibiotics," Jacobs said. "The worst-case scenario is where you go back to a situation of limited antibiotic use," leading to amputations and deaths.

As a start, the state will use a $95,000 grant from the U.S. Centers for Disease Control and Prevention to fund programs to fight microbial resistance and to promote appropriate use of antibiotics.

The strategic plan calls for informing the public, particularly minority groups, about the high cost of infections by resistant bacteria. That could include distributing informational materials in English and Spanish through health care providers, airing radio and TV public service ads, and posting information for the public and media on the health department's Web site.

Dr. Eddy Bresnitz, the state epidemiologist, noted a survey this year found nearly half of New Jersey residents said they expect to get an antibiotic prescription if they are sick enough with a cold or respiratory problem to call or see a doctor.

"The doctors actually to give it to them because they feel a lot of pressure," Jacobs said _ even though antibiotics have no effect on the viruses that cause most coughs, colds and childhood ear infections.

While antibiotics have cured and prevented countless infections since the 1940s, improper use has helped microbes develop resistance to standard and even intravenous antibiotics, making it harder to treat everything from routine infections and gonorrhea to tuberculosis and malaria. The CDC estimates about 90,000 patients die each year from infections acquired in hospitals. Some of the more virulent bugs, including a type of Staph infection known by the acronym MRSA, have been infecting athletes in contact sports and even quickly killing young, healthy children.

One U.S. study found that if a bloodstream infection by the bacterium Enterococcus is resistant to the super-antibiotic vancomycin, rather than susceptible to it, patient hospital stays were prolonged by 18 days, $27,190 was added to hospital costs and risk of death rose 29 percent.

Under the strategic plan, hospitals will focus on tracking antibiotic-resistant strains of several bacteria that are common and very dangerous, and reports will be submitted to the state electronically, allowing better analysis. Prisons and long-term acute-care facilities are interested in doing that as well, and the tracking could be expanded to nursing homes, private doctor's offices and home care agencies, if funding is available, Bresnitz said.

Meanwhile, a second grant _ $181,900 from the Healthcare Foundation of New Jersey _ will support a joint project of the health department and the hospital association to reduce the urinary tract infections often triggered by use of catheters in hospitals, nursing homes and home health care.

Holmes said New Jersey's 81 acute care hospitals have all been working on infection control. She hopes the statewide effort, by sharing hospitals' best infection-control strategies and other information, helps hospital workers realize how their daily actions, such as whether they wear sterile gloves, can affect the scope of antibiotic resistance.

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On the Net:

Task Force report: http://www.state.nj.us/health/cd/mrsa/documents/mrsa_strategic_plan.pdf