• Healthcare-Acquired Infections and Drug Resistance

    September 26, 2019 0

    Jia-Yia Liu, MD

    ● President and Director of AMPSAA
    ● Assistant Clinical Professor, Department of Medicine at Loma Linda University
    ● Attending Physician at Cedars-Sinai Medical Center

    In the United States, health-care acquired infections (HAIs) also known as nosocomial infections (NIs) cost $28 to $34 billion annually. It is estimated that $25 to $32 billion of these costs could be prevented. [1],[2] Of the 1.7 million HAI cases that occur yearly, 99,000 hospitalized patients will die. This number is an underestimate because HAIs occur in both inpatient and outpatient settings. [3]  In addition to death, the direct devastating consequences of HAIs include significant morbidity and economic burden.[4] The increased use of antimicrobials for HAIs, both appropriately and inappropriately, promotes the development of drug resistant organisms.  For the past 76 years, antibiotics have saved millions of lives and allowed medical and surgical care including complex surgical procedures, cancer chemotherapy, transplant medicine and intensive care treatment to flourish.  However, this honeymoon period began to end in 1996 when the last novel gram-negative antibiotic class was introduced: the fluoroquinolones. Unfortunately, microbial resistance rates will always outpace antibiotic development as bacterial drug resistance genes can encode multiple genetic mechanisms of resistance to a single antibiotic or produce one efficient gene of resistance that extends across an entire related class of several antibiotics. [5],[6] The microbiological world is truly global and without boundaries. How we use antibiotics in the US affects the rest of the world and how the world uses antibiotics affects how we practice medicine. In 2013, the CDC listed 18 resistant bacterial and fungal organisms as “Serious and Urgent Threats to the World”[7]; Vancomycin Resistant Staphylococcus aureus, Extended Spectrum Beta Lactamase E. coli, Carbapenamase Resistent Klebsiella,  Multidrug Resistant Tuberculosis, and Fluconazole resistant Candida are only a few of those on the list. We as a world community have bred these organisms in our hospitals, in our patients, in our families and in ourselves through the use of antibiotics in agriculture and in healthcare.  Unless we change how we grow our food and how we prescribe and take antibiotics, the world will continue to see more deaths from once treatable infectious diseases. Governments and pharmaceutical industries[8] should be encouraged to support novel antimicrobial drug development.  Antibiotic stewardship programs[9] are obligatory. Minimizing nosocomial infections and avoiding the knee-jerk response to prescribe antibiotics will preserve our current antimicrobial arsenal, save countless lives and eliminate billions of dollars in healthcare costs.  


    1. Scott R. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Website https://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf Accessed Sept 23, 2019.
    2. The Leapfrog Group. Healthcare-Associated Infections. Website https://www.leapfroggroup.org/sites/default/files/Files/Leapfrog-Castlight%202018%20HAI%20Report.pdf 2017. Accessed Sept 23, 2019.
    3. Khan H, Baig F, et al. Nosocomial Infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 2016. 7(5): 478-482.
    4. Brennan T, Lucian L, et al. Incidence of Adverse Events and Negligence in Hospitalized Patients-Results of the Harvard Medical Practice Study I. NJEM, 1991. 324:370-376.
    5. Borna M, Clark N, et al. Antimicrobial Resistance in Hospital-Acquired Gram-Negative Bacterial Infections. Chest, 2015; 147(5):1413-1421.
    6. Peleg A, Hooper D. Hosptial-Acquired Infections Due to Gram-Negative Bacteria. NEJM, 2010. 362:1804-1813.
    7. Antibiotic Resistance Threats in the United States, 2013. Website https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf Accessed September 23, 2019.
    8. Talbot G, Jezek A, et al. The Infectious Diseases Society of America’s 10 x ‘20 Initiative (10 NEw Systemic Antibacterial Agents US Food and Drug Administration Approved by 2020):Is 20 x 20’ a Possibility? Clinical Infectious Diseases, 2019. 69 (1):1-11.
    9. Zilahi G, Artigas A, et al. What’s new in multidrug-resistant pathogens in the ICU? Ann Intensive Care, 2016. 6:96.

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