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Emerging Infectious Diseases logoLink to Emerging Infectious Diseases
. 2001 Mar-Apr;7(2):188–192. doi: 10.3201/eid0702.010206

Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics.

R A Weinstein 1
PMCID: PMC2631704  PMID: 11294703

Abstract

Antimicrobial-drug resistance in hospitals is driven by failures of hospital hygiene, selective pressures created by overuse of antibiotics, and mobile genetic elements that can encode bacterial resistance mechanisms. Attention to hand hygiene is constrained by the time it takes to wash hands and by the adverse effects of repeated handwashing on the skin. Alcohol-based hand rubs can overcome the time problem and actually improve skin condition. Universal glove use could close gaps left by incomplete adherence to hand hygiene. Various interventions have been described to improve antibiotic use. The most effective have been programs restricting use of antibiotics and computer-based order forms for health providers.

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Selected References

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  1. Austin D. J., Bonten M. J., Weinstein R. A., Slaughter S., Anderson R. M. Vancomycin-resistant enterococci in intensive-care hospital settings: transmission dynamics, persistence, and the impact of infection control programs. Proc Natl Acad Sci U S A. 1999 Jun 8;96(12):6908–6913. doi: 10.1073/pnas.96.12.6908. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Beezhold D. W., Slaughter S., Hayden M. K., Matushek M., Nathan C., Trenholme G. M., Weinstein R. A. Skin colonization with vancomycin-resistant enterococci among hospitalized patients with bacteremia. Clin Infect Dis. 1997 Apr;24(4):704–706. doi: 10.1093/clind/24.4.704. [DOI] [PubMed] [Google Scholar]
  3. Bonhoeffer S., Lipsitch M., Levin B. R. Evaluating treatment protocols to prevent antibiotic resistance. Proc Natl Acad Sci U S A. 1997 Oct 28;94(22):12106–12111. doi: 10.1073/pnas.94.22.12106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bonten M. J., Hayden M. K., Nathan C., van Voorhis J., Matushek M., Slaughter S., Rice T., Weinstein R. A. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet. 1996 Dec 14;348(9042):1615–1619. doi: 10.1016/S0140-6736(96)02331-8. [DOI] [PubMed] [Google Scholar]
  5. Boyce J. M., Opal S. M., Chow J. W., Zervos M. J., Potter-Bynoe G., Sherman C. B., Romulo R. L., Fortna S., Medeiros A. A. Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. J Clin Microbiol. 1994 May;32(5):1148–1153. doi: 10.1128/jcm.32.5.1148-1153.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Durbin W. A., Jr, Lapidas B., Goldmann D. A. Improved antibiotic usage following introduction of a novel prescription system. JAMA. 1981 Oct 16;246(16):1796–1800. [PubMed] [Google Scholar]
  7. Evans R. S., Pestotnik S. L., Classen D. C., Clemmer T. P., Weaver L. K., Orme J. F., Jr, Lloyd J. F., Burke J. P. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med. 1998 Jan 22;338(4):232–238. doi: 10.1056/NEJM199801223380406. [DOI] [PubMed] [Google Scholar]
  8. Gerding D. N. Antimicrobial cycling: lessons learned from the aminoglycoside experience. Infect Control Hosp Epidemiol. 2000 Jan;21(1 Suppl):S12–S17. doi: 10.1086/503168. [DOI] [PubMed] [Google Scholar]
  9. Goldmann D. A., Weinstein R. A., Wenzel R. P., Tablan O. C., Duma R. J., Gaynes R. P., Schlosser J., Martone W. J. Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in Hospitals. A challenge to hospital leadership. JAMA. 1996 Jan 17;275(3):234–240. [PubMed] [Google Scholar]
  10. John J. F., Jr Antibiotic cycling: is it ready for prime time? Infect Control Hosp Epidemiol. 2000 Jan;21(1):9–11. doi: 10.1086/501689. [DOI] [PubMed] [Google Scholar]
  11. Johnson S., Gerding D. N., Olson M. M., Weiler M. D., Hughes R. A., Clabots C. R., Peterson L. R. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med. 1990 Feb;88(2):137–140. doi: 10.1016/0002-9343(90)90462-m. [DOI] [PubMed] [Google Scholar]
  12. Kollef M. H., Vlasnik J., Sharpless L., Pasque C., Murphy D., Fraser V. Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med. 1997 Oct;156(4 Pt 1):1040–1048. doi: 10.1164/ajrccm.156.4.9701046. [DOI] [PubMed] [Google Scholar]
  13. Landman D., Chockalingam M., Quale J. M. Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary. Clin Infect Dis. 1999 May;28(5):1062–1066. doi: 10.1086/514743. [DOI] [PubMed] [Google Scholar]
  14. Larson E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis. 1999 Nov;29(5):1287–1294. doi: 10.1086/313468. [DOI] [PubMed] [Google Scholar]
  15. Matushek M. G., Bonten M. J., Hayden M. K. Rapid preparation of bacterial DNA for pulsed-field gel electrophoresis. J Clin Microbiol. 1996 Oct;34(10):2598–2600. doi: 10.1128/jcm.34.10.2598-2600.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Olsen R. J., Lynch P., Coyle M. B., Cummings J., Bokete T., Stamm W. E. Examination gloves as barriers to hand contamination in clinical practice. JAMA. 1993 Jul 21;270(3):350–353. [PubMed] [Google Scholar]
  17. Pittet D., Mourouga P., Perneger T. V. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med. 1999 Jan 19;130(2):126–130. doi: 10.7326/0003-4819-130-2-199901190-00006. [DOI] [PubMed] [Google Scholar]
  18. Quale J., Landman D., Saurina G., Atwood E., DiTore V., Patel K. Manipulation of a hospital antimicrobial formulary to control an outbreak of vancomycin-resistant enterococci. Clin Infect Dis. 1996 Nov;23(5):1020–1025. doi: 10.1093/clinids/23.5.1020. [DOI] [PubMed] [Google Scholar]
  19. Rahal J. J., Urban C., Horn D., Freeman K., Segal-Maurer S., Maurer J., Mariano N., Marks S., Burns J. M., Dominick D. Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella. JAMA. 1998 Oct 14;280(14):1233–1237. doi: 10.1001/jama.280.14.1233. [DOI] [PubMed] [Google Scholar]
  20. Schiff G. D., Rucker T. D. Computerized prescribing: building the electronic infrastructure for better medication usage. JAMA. 1998 Apr 1;279(13):1024–1029. doi: 10.1001/jama.279.13.1024. [DOI] [PubMed] [Google Scholar]
  21. Slaughter S., Hayden M. K., Nathan C., Hu T. C., Rice T., Van Voorhis J., Matushek M., Franklin C., Weinstein R. A. A comparison of the effect of universal use of gloves and gowns with that of glove use alone on acquisition of vancomycin-resistant enterococci in a medical intensive care unit. Ann Intern Med. 1996 Sep 15;125(6):448–456. doi: 10.7326/0003-4819-125-6-199609150-00004. [DOI] [PubMed] [Google Scholar]
  22. Tenover F. C., Arbeit R. D., Goering R. V. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Molecular Typing Working Group of the Society for Healthcare Epidemiology of America. Infect Control Hosp Epidemiol. 1997 Jun;18(6):426–439. doi: 10.1086/647644. [DOI] [PubMed] [Google Scholar]
  23. Tenover F. C. Novel and emerging mechanisms of antimicrobial resistance in nosocomial pathogens. Am J Med. 1991 Sep 16;91(3B):76S–81S. doi: 10.1016/0002-9343(91)90347-z. [DOI] [PubMed] [Google Scholar]
  24. Weinstein R. A. Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med. 1991 Sep 16;91(3B):179S–184S. doi: 10.1016/0002-9343(91)90366-6. [DOI] [PubMed] [Google Scholar]
  25. Weinstein R. A., Kabins S. A. Strategies for prevention and control of multiple drug-resistant nosocomial infection. Am J Med. 1981 Feb;70(2):449–454. [PubMed] [Google Scholar]
  26. White A. C., Jr, Atmar R. L., Wilson J., Cate T. R., Stager C. E., Greenberg S. B. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis. 1997 Aug;25(2):230–239. doi: 10.1086/514545. [DOI] [PubMed] [Google Scholar]
  27. Wiener J., Quinn J. P., Bradford P. A., Goering R. V., Nathan C., Bush K., Weinstein R. A. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA. 1999 Feb 10;281(6):517–523. doi: 10.1001/jama.281.6.517. [DOI] [PubMed] [Google Scholar]
  28. Woodward R. S., Medoff G., Smith M. D., Gray J. L., 3rd Antibiotic cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital. Am J Med. 1987 Nov;83(5):817–823. doi: 10.1016/0002-9343(87)90636-x. [DOI] [PubMed] [Google Scholar]

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