Long-term, acute care hospitals breed antibiotic resistance.
"Long-term, acute care hospitals (LTACHs) are an ideal setting for the convergence of risk factors for antibiotic resistance," Dr. Carolyn V. Gould said at the annual meeting of the Society for Healthcare Epidemiology of America. "They have compromised patients with a very high rate of colonization with resistant organisms at the time they are admitted. Patients have a high rate of antibiotic use and prolonged hospital stays, and face multiple sources of infection," said Dr. Gould, an infectious diseases physician at Emory University in Atlanta.
Her study examining the scope of the problem and its causes is a first step toward trying to devise ways to minimize the spread of antibiotic resistance at LTACHs, she said.
LTACHs are relatively new health care facilities that specialize in the care of patients who need extended hospitalization with intensified care. Many patients at LTACHs are transferred from intensive care units, and they often need prolonged mechanical ventilation. Dr. Gould and her associates noted the high prevalence of antibiotic-resistant isolates at the LTACH affiliated with Emory Crawford Long Hospital, where she works, and decided to make the first large-scale survey of antibiotic-resistant bacteria at American LTACHs.
More than 300 LTACHs now exist in the United States; the survey began with 25 centers. The study is now expanding to include a total of 65 centers.
The survey results showed that patients at the LTACHs studied had a median 29-day length of stay, and that the extent of antibiotic usage was similar to the usage at intensive care units in the National Nosocomial Infection Surveillance System of the Centers for Disease Control and Prevention.
The results also showed that antibiotic resistance was highly prevalent. Among the Staphylococcus aureus isolates tested, a median of 84% were methicillin resistant. Among Enterococcus species, a median of 33% were vancomycin resistant. Among Pseudomonas species, a median of 78% were resistant to fluoroquinolones, and a median of 23% were resistant to piperacillin. In Klebsiella isolates, a median of 36% were resistant to ceftazidime. And in the Escherichia coli isolates, a median of 47% were resistant to fluoroquinolones.
BY MITCHEL L. ZOLER
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|Title Annotation:||Infectious Diseases|
|Author:||Zoler, Mitchel L.|
|Publication:||Internal Medicine News|
|Date:||Sep 15, 2004|
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