Multidrug-Resistant Bacterial Infections: Key Messages

Peter L. Salgo, MD; Andrew Shorr, MD; Debra Goff, PharmD, FCCP; Sandy J. Estrada Lopez, PharmD, BCPS (AQID); and Jason Pogue, PharmD, BCPS-AQID, close their discussion by highlighting take-home messages and emphasizing the importance of healthcare provider hygiene, not just for multidrug-resistant bacterial infections but in all settings.

Peter L. Salgo, MD: What about anything else, before we leave this topic, inside or outside the hospital to combat resistance other than what we’ve been discussing?

Andrew Shorr, MD: The best way to prevent resistance is to prevent an infection that needs an antibiotic, period.

Debra Goff, PharmD, FCCP: Vaccines.

Andrew Shorr, MD: The Ds that have been described with the antibiotic piece, the whole prevention piece, whether it’s vaccines or more importantly, the simple things that we do in the ICU every day—the bed elevation, using OG tubes versus NG tubes, decrease sedation and the bundle leading to earlier liberation from the ventilator.

Debra Goff, PharmD, FCCP: Wash your hands.

Peter L. Salgo, MD: Oh wait, she just said it. Wash your hands.

Andrew Shorr, MD: If patients actually saw what true hand hygiene compliance rates were in the hospital, they would be appalled and we all know it’s an issue.

Peter L. Salgo, MD: I’m appalled. I don’t want to leave this because the appall factor just rose up to nauseate me. Why is it so darn hard to get health care professionals to wash their hands? What’s going on here? Anybody have an answer? Please. Nothing.

Andrew Shorr, MD: So, again, one of the best interventions that has been effected to actually change prescribing or hand hygiene practices was the secret shopper approach. And I don’t mean secret shopper where nurse X is auditing her colleagues in the ICU or even cross it. It’s a hidden camera, and there are some data from North Shore—or whatever they call themselves this month, North Health or whatever—where you didn’t know if the camera is on or not so you don’t know if you’re being watched or not, and they actually tracked hand hygiene compliance and it went up really substantially.

Peter L. Salgo, MD: I just don’t get it.

Andrew Shorr, MD: So, it’s like preventing shoplifting.

Peter L. Salgo, MD: I just don’t get it. If only for your own protection and for your family’s protection, you’re going to bring these things home. Why don’t you wash your hands?

Andrew Shorr, MD: We’ve got the dispensers outside of every room, and we just can’t get environmental services to refill the dispensers.

Peter L. Salgo, MD: So, at least people are using them.

Andrew Shorr, MD: We use them and they’re empty and the people are like, “Well, why am I going back to try to use this? It’s empty.” And so, it creates another negative reinforcement.

Peter L. Salgo, MD: Except that they don’t work for C. diff, so good luck on that one, too.

Andrew Shorr, MD: Right, soap and water is still good.

Peter L. Salgo, MD: We could go on for the next year because this is one of these things that just appalls me personally. Wash your hands! Cut it out! Wash it off! Those days are gone. Lister did prove this, right? You can sanitize the human skin better than what we’re doing. Alright enough because I just get angry and pound the table. I don’t want to do that because we’ve got a great discussion, and now it’s time for us to go around the table once and to leave our viewers with at least one takeaway point that each of you thinks is important. So, why don’t we start with Dr. Estrada?

Sandy J. Estrada Lopez, PharmD, BCPS (AQID): Sure. So, I think it’s an exciting time to be doing infectious diseases and antimicrobial stewardship. And the key point that I have seen so far is collaboration. So, if you look at everything we’ve talked about today, really just working together, educating each other, and understanding how the role that we play can make a difference for patient care will lead us to the next steps in the future of decreasing antimicrobial resistance.

Peter L. Salgo, MD: Dr. Goff?

Debra Goff, PharmD, FCCP: Well, I think the responsible use of antibiotics is really a shared role between healthcare providers, patients, and consumers. And we have to continue to educate all 3 groups in order to win this battle against antibiotic resistance.

Peter L. Salgo, MD: Dr. Pogue?

Jason Pogue, PharmD, BCPS-AQID: Yes. Obviously, I want to just echo what you guys said. But in addition, I think that a key component of stewardship, as you’ve heard, is getting patients on the right antibiotic. That involves taking patient-specific information, local epidemiology information, and, where it’s appropriate, newer antimicrobials fit into that story as well. And so, really think what’s best for your patient as well as the hospital and get your patient on the best therapy.

Peter L. Salgo, MD: Dr. Shorr?

Andrew Shorr, MD: I think to build on this theme of team sport and collaboration, we need to bring in people outside the institutions besides patients and patient advocates. And we really need to be appealing to our policy makers and our legislators to really realign incentives, so that quality payments actually reflect quality behavior as opposed to just punishments for the hospital, so that pharmaceutical developers actually have legitimate incentives to risk the capital to go in and develop antibiotics that don’t pay the way chronic cancer therapies do. And all of these things need to change at a national level if we’re going to actually have the tools we need and the shift in mentality where we realize that antibiotics are a public resource and, therefore, require public stewardship.

Peter L. Salgo, MD: Well, I want to thank all of you. If I have one message for you before we go, it’s please wash your hands. Just do this. This is simple stuff. And with that, I want to thank all of you for being here, I want to thank all of you for watching as well. It has been a great discussion. I think I speak for everybody here to say thanks for watching. Thanks for joining us. I’m Dr. Peter Salgo and I’ll see you next time.