A Growing Threat to Public Health
Each year, nearly 2 million patients in the United States
get an infection as a result of receiving health care in a hospital. These hospital-acquired
infections are often difficult to treat because the bacteria and other microorganisms
that cause them frequently are resistant to antimicrobial drugs.
Bacteria, fungi, and even viruses can become resistant to
drugs. However, bacteria cause most of the drug-resistant problems in hospitals.
Bacteria can become resistant to antibiotics in a variety of ways. And once
a particular type of bacteria has developed resistance to a drug, it can pass
on this resistance to other types of bacteria.
Overall, 70% of the bacteria causing such infections are
resistant to at least one of the drugs most commonly used to treat these infections.
In some cases, these organisms are resistant to all approved antibiotics and
must be treated with experimental and potentially very toxic drugs.
The more often a drug is used, the more likely bacteria are
to develop resistance to it. For this reason, and to combat the problem of drug-resistant
bacteria, CDC has developed recommendations to help ensure that drugs are prescribed
only when appropriate. These recommendations, together with other CDC guidelines
for infection control, are helping to limit the spread of drug-resistant infections
in the nation's hospitals.
What has been the impact of antibiotic resistance on the problem of
hospital-acquired infections?
Antibiotic resistance is a major contributor to the
disease, death, and costs resulting from hospital-acquired infections. Unfortunately,
we don't yet have precise numbers. There is a great need for studies in this
area. One report placed the annual cost of antimicrobial resistance among a
single pathogen (Staphylococcus aureus) at $122 million.
What's being done about this?
CDC and other healthcare organizations, such as the Society
for Healthcare Epidemiology of America, the Association for Professionals in
Infection Control and Epidemiology, the Infectious Diseases Society of America,
and the American Academy of Pediatrics, are working to improve antimicrobial
prescription practices. For example, in late 1997 CDC sponsored a national videoconference
for healthcare workers to improve the use of vancomycin, a first-line drug used
to combat serious staphylococcal and enterococcal infections. Another videoconference
on antimicrobial use was held in late1998. And we're making our guidelines available
in new ways, e.g., over the Internet.
Do doctors overprescribe antibiotic drugs in hospital and health care
settings?
CDC and other healthcare organizations have developed guidelines
for the use of antibiotics in hospitals; however, some research indicates that
antibiotics are being used more than the guidelines recommend. For example,
one recent study indicated that as much as 60% of the hospital prescriptions
for one of these drugs, vancomycin, are not in accordance with the guidelines.
What are the most common patient mistakes with antibiotics?
Asking for antibiotics they don't need, e.g., as treatment
for viral infections, such as colds, which don't respond to antibiotics. Not
taking antibiotics as prescribed, especially stopping before the prescription
runs out (thus, they may not kill all the infecting organisms and they leave
the most resistant ones behind to continue to grow). Saving antibiotics and
later self-prescribing them.
What should a hospital do to address the problem of antimicrobial resistance?
The hospital should monitor antibiotic use and resistance,
provide guidelines for antimicrobial use and for preventing the spread of resistant
bacteria within the hospital, and monitor compliance with these guidelines.
Are most doing this?
Because there are no current standards for antibiotic use
such as those the Joint Commission on Accreditation of Healthcare Organizations
sets for infection control, we don't have a clear picture on this. But we think
the percentage of hospitals with adequate programs for monitoring antimicrobial
use and resistance is much smaller than the percentage with effective infection
control programs.
June 1999
Division of Healthcare Quality Promotion
National Center for Infectious Diseases
Centers for Disease Control and Prevention
Atlanta, GA
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Treatment of psoriasis is determined by the location, severity and history of psoriasis in each individual. There is no one method of treatment, for each person with psoriasis may respond differently. One main objective of treatment is to slow down the more rapid than usual growth rate of the skin cells. The rapid growth rate of skin cells causes the red, scaly psoriasis patches. The underlying cause of this increased skin growth is not yet known. For patients with minimal psoriasis, therapy is limited to topical medications that are drugs applied to the skin. For patients with moderate to widespread psoriasis, topical treatments are often combined with ultraviolet light therapy. Either sunlight or artificial ultraviolet light therapy can be used. If topical and ultraviolet light therapy are not effective, or are not practical, systemic or oral medications can be used. These may be combined with ultraviolet light therapy, the so-called photo-chemotherapy or PUVA therapy. In severe cases and unresponsive cases of psoriasis, there are oral medications that slow down the growth rate of skin which are helpful. These drugs can have significant side effects and have to be used with the proper safeguard and caution. Even these strong drugs do not cure psoriasis but only help to control the disease.
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