Health care-associated infections and antibiotic resistance rise in US hospitals

A new National Institutes of Health study has found increases in both health care-associated infections and resistance to the antibiotics used to treat them.

The results draw on information collected from 120 US hospitals between January 2018 and December 2022, a five-year span that included the COVID-19 pandemic.

Dr Nasia Safdar, professor of infectious disease at the University of Wisconsin-Madison, explains why infection rates have risen and what hospital patients and visiting relatives can do to protect themselves.

The Conversation worked with SciLine to present edited highlights of the discussion for clarity and brevity.

Understanding health care-associated infections

What are health care-associated infections?

Nasia Safdar: Health care-associated infections are caused by exposure to the health care system. People who arrive for treatment are often already very unwell, making them more likely to pick up bacteria that may cause an infection during their hospital stay or shortly after they leave hospital.

Why do infections, particularly antibiotic-resistant ones, spread so easily in hospitals and other health care settings?

Nasia Safdar: Health care facilities develop a particular mix of bacteria and germs. This usually includes bacteria that resist many antibiotics commonly used in treatment.

Patients are already at risk and may have weakened immune systems. That vulnerability is compounded by intensive antibiotic use, operations, medical procedures and devices such as urinary catheters and intravascular catheters, which enter the bloodstream.

Together, these factors create a population vulnerable to the bacteria present in the environment.

What does it mean for an infection to be antibiotic-resistant?

Nasia Safdar: A routine infection can often be treated using several options. The first-line treatment is the antibiotic normally chosen first. These medicines generally treat infections effectively without damaging the beneficial bacteria in the intestine.

However, once bacteria become resistant to antibiotics, doctors must use broader-spectrum antibiotics. Although these may still work, they can produce more side effects or eliminate some of the beneficial bacteria in the intestine.

Preventing infections in hospitals and clinics

What can hospitals and clinics do to prevent or reduce the spread of infections?

Nasia Safdar: Two approaches are important: infection prevention and antibiotic stewardship, meaning antibiotics are used judiciously. These measures reinforce one another.

Infection prevention includes hand hygiene, which is vital for both health care staff and patients.

Gowns and gloves should also be used when needed. If a patient has a transmissible condition, health care workers wearing appropriate PPE, or personal protective equipment, can interrupt that route of transmission.

Another way to lower infection risk is to use devices, including urinary catheters and intravascular catheters, only when they are genuinely necessary.

Antibiotic stewardship, meanwhile, requires avoiding the excessive use of antibiotics.

What has happened in recent years regarding the rates of health care-associated infections?

Nasia Safdar: Before the pandemic, the field had reason for optimism because rates of antibiotic-resistant infections linked to medical devices were falling.

Many of those improvements were undone when the pandemic began. Antibiotics were frequently used unnecessarily during that period, and sharp rises are now being seen in many antibiotic-resistant bacteria.

This has raised concerns that earlier progress was fragile and did not last long. The aim now is to ensure health care systems are not as vulnerable as they proved to be during the pandemic.

Candida auris, the gut microbiome and patient protection

Can you give us some background on Candida auris?

Nasia Safdar: Candida auris is an emerging pathogen. Unlike certain other antibiotic-resistant germs found in health care systems, it is a fungus - also described as a yeast - and it spreads rapidly through health care settings.

Candida auris can remain on skin and in the environment, and may cause serious bloodstream infections in vulnerable patients. It has caused a number of outbreaks, while treatment choices are far more restricted than for other infectious germs.

When the pandemic arrived, Candida auris infections increased sharply. After rising slowly for some time, they climbed by several hundred percent nationwide. That sudden increase is worrying.

Can the spread of these infections be reduced by manipulating the gut microbiome?

Nasia Safdar: Many of these germs live in the intestine, where they are usually controlled by the beneficial bacteria we all carry. Yet antibiotics, medical devices and surgery can destroy those good bacteria. The germs can then occupy a favourable niche, multiply and cause infection.

Diet is important for maintaining a healthy gut microbiome. Most Americans do not consume enough fibre, but a high-fibre diet supports healthy gut bacteria and can help the body resist invading germs.

What can patients or their families do to reduce the odds of getting an infection in a health care setting?

Nasia Safdar: Ensure that patients and health care workers both practise good hand hygiene. Use hand sanitiser: it is effective, convenient, readily available and an excellent way to prevent infections in health care systems.

In some situations, however, soap and water are preferable. They are the better choice if hands are contaminated with blood, stool, diarrhoea or other bodily secretions.

Patients and families should also ask about a health care system's infection rates. Health care systems generally monitor these closely, and the information is often publicly available.

Ask the health care team about medicines being provided, especially antibiotics. Find out how long they should be taken, which side effects to expect and how they may affect gut bacteria.

Watch the full interview to hear more.

SciLine is a free service based at the American Association for the Advancement of Science, a non-profit organisation that helps journalists incorporate scientific evidence and experts into news stories.

Nasia Safdar, Professor of Infectious Disease, University of Wisconsin-Madison

This article is republished from The Conversation under a Creative Commons licence. Read the original article.