Antibiotic resistant organisms a growing problem worldwide

Antimicrobial resistant organisms are a common cause of infections in healthcare facilities. Such infections are difficult to treat and are associated with poorer outcomes for patients and increased costs.

A recent Australia point prevalence survey (snapshot) in 19 hospitals across Australian states/territories noted 1 in 10 patients had a hospital associated infection. The three most common infections were a wound infection after surgery, pneumonia and urinary tract infection. These infections accounted for 64% of all healthcare associated infections identified. In addition the presence of an antibiotic resistant organism was documented in 10.3% of the patients.¹

Problem antimicrobial resistant organisms include MRSA (often referred to as golden staph), Vancomycin-resistant Enterococci (VRE), Carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae (CPE), a group of gram-negative bacteria that are resistant to the carbapenem class of antibiotics (antimicrobials used in treating invasive or life-threatening infections), and more recently Candida auris a yeast, resistant to multiple antifungal drugs.

Candida auris (C. auris) is spreading worldwide. C. auris can cause invasive infections (i.e. bloodstream) and large scale persistent outbreaks in hospitals are being increasingly reported. An example being a large C. auris outbreak in New York, involving 277 clinical cases and 350 surveillance cases where 151 facilities were impacted from August 2016 to October 2018 including 59 hospitals, 92 nursing homes, 1 long-term acute care hospital (LTACH), and 2 hospices.²

More than 1 in 3 patients with invasive C. auris infection die.

C. auris can readily colonize human skin and survive on dry surfaces for weeks. When people in healthcare facilities are colonized (persons carrying the organism but it is not making them sick) or infected they shed the pathogen from their skin into their surroundings, which can get on other people or nearby objects, allowing the organism to spread.³

C. auris is a serious global health threat. Even if healthcare facilities have not had a case of C. auris they need to be well prepared because spread can be unrecognised and outbreaks are extremely difficult to control. Adherence to local infection prevention and control recommendations such as the “Victorian Guideline on Candida auris for health services” will be crucial.⁴

In 2018, carbapenemase-producing Enterobacteriaceae (CPE) were the most commonly reported Critical Antimicrobial Resistances (CARs) in Australia.⁵

Throughout Europe carbapenem-resistant Klebsiella pneumoniae are rapidly spreading. A recent European Survey, collected through the European Survey of Carbapenemase-Producing Enterobacteriaceae, analysed the genome sequences (genetic information in an organism) of >1,700 K. pneumoniae samples taken from patients in 244 hospitals in 32 countries to determine how it was spreading.

Sophia David, lead author of the study, said, “Our findings imply hospitals are the key facilitator of transmission: over half of the samples carrying a carbapenemase gene were closely related to others collected from the same hospital, suggesting that the bacteria are spreading from person to person primarily within hospitals.” ^6,7

Hajo Grundmann, co-lead author, said, “This research emphasises the importance of infection control and ongoing genomic surveillance of antibiotic resistant bacteria to ensure we detect new resistant strains early and act to combat the spread of antibiotic resistance.”

Genome sequencing will enhance traditional infection prevention surveillance allowing staff to determine any geo-temporal relatedness to validate or exclude cross transmission events.

In addition there is now substantial evidence that contamination of surfaces in hospital rooms plays an important role in the spread of antibiotic resistant organisms. Organism can persist in the environment for hours to days, and in some cases months, frequently contaminating surfaces in patient rooms and medical equipment.

Unfortunately routine and discharge cleaning of room surfaces and medical equipment is frequently inadequate. Multiple studies have shown <50% of hospital room surfaces are adequately cleaned and it has now been established there is an increased risk of resistant organism acquisition from prior room occupant.

Enhanced daily and discharge disinfection in addition to cleaning will be vital in controlling resistant organisms. Healthcare facilities will need to select a disinfectant that has kill claims for the pathogens, a rapid kill and short kill/contact time, good cleaning properties, is nontoxic, proven compatibility with common healthcare surfaces and equipment, is easy to use and has an odour deemed acceptable by users and patients.

The Diversey one-step Accelerated Hydrogen Peroxide range including Oxivir® Tb and Sporicide Plus wipes meet all key selection criteria for cleaning and disinfection.

For more information, visit http://www.diverseyvericlean.com/diversey-vericlean-system/products/disinfectants.

References

1. Russo, et al. The prevalence of healthcare associated infections among adult inpatients at nineteen large Australian acute-care public hospitals: a point prevalence survey. Antimicrobial Resistance and Infection Control (2019) 8:114.
2. Zhu Y, et al. "Laboratory Investigations of Candida auris Outbreak, New York 2016- 2018: Sample Source Diversity, Fungal Species Spectrum, Antifungal Resistance Patterns, and Genotypes" ASM Microbe 2019; Abstract Sunday-CPHM-889.
3. Sexton J, et al. "Mechanisms of Candida auris Transmission within the Healthcare Environment" ASM Microbe 2019; Abstract Sunday-CIV-LB-3.
4. Victorian Guideline on Candida auris for health services https://www2.health.vic.gov.au/public-health/infectious-diseases/infection-control-guidelines.
5. Australian Commission on Safety and Quality in Health Care (ACSQHC). AURA 2019: third Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC; 2019.
6. Wellcome Sanger Institute. Hospitals key in the spread of extremely drug resistant bacteria in Europe. 2019. https://www.sanger.ac.uk/news/view/hospitals-key-spread-extremelydrug-resistant-bacteria-europe.
7. Superbug spreads in European hospitals as resistance to last resort antibiotics grows.