Becker's Clinical Quality & Infection Control

20 ANTIBIOTIC RESISTANCE Hospital Beds' Antibiotic History Can Put Future Patients at Risk for C. diff By Heather Punke W hen a patient in a hospital bed receives antibiotics, it puts the beds' next occupant at an increased risk of a Clostridium difficile infec- tion, according to a study published in JAMA Internal Medicine. is means "antibiotics can directly affect risk for [C. diff infection] in patients who do not themselves receive antibiotics," according to the study authors. To examine this trend, researchers looked at patients in four New York City-area hospitals who were admitted from 2010 to 2015. ey had to spend more than 48 hours in their hospital bed, and the previous patient had to spend at least 24 hours in the bed no more than week prior to the second patient's admittance. Using data from a computerized clinician order entry system, researchers determined if the first patient received antibiotics or not. Out of 100,615 pairs of patients who occu- pied a given hospital bed sequentially, the second patient developed a C. diff infection in 576 pairs. Overall, the risk of a C. diff infection in the second patient was 0.72 percent when the first patient received antibiotics and just 0.43 percent when the first patient did not receive antibiotics. "is study provides evidence that there is a heard effect with antibiotics. In other words, antibiotics have the potential to affect the health of people who don't themselves receive antibiotics," Daniel Freedberg, MD, an author of the study, told Health Day. As for why the C. diff risk does increase, the researchers suggested further study. How- ever, they posit that if patients are colonized with C. diff, antibiotics can promote the bac- teria proliferation and the number of spores shed into the environment. One physician not affiliated with the study suggested to Health Day that fur- ther cleaning of hospital beds could be necessary. "This underscores the idea that hospitals are not being sanitized enough or they can't be sanitized enough," said Marc Siegel, MD, a professor at NYU Langone Medical Center. "There is an increased need for increased sterilization procedures between patients." n Many Superbug Deaths in US Go Uncounted: 4 Things to Know By Brian Zimmerman A s the prevalence of antibiotic-resistant superbugs continues to rise in the United States, many deaths caused by these infections are not being tracked, which may be inhibiting efforts to combat the rise of these deadly and costly infections, according to an investigative report from Reuters. Here are four key takeaways from the Reuters investigation: 1. The report relays several individual instances of patients' death certificates not accurately conveying the cause of death. In one such case, the death certificate of an infant infected with methicillin-resistant Staphylococ- cus aureus made no mention of the infection. Instead, the cause of death listed on the certificate was "sepsis due to (or as a consequence of): Prematurity." The sepsis arose as a complication of MRSA. 2. Acknowledging hospital-acquired infections related to superbugs can result in costly legal liability, loss of reim- bursements and detrimental impacts to public relations, meaning hospitals may not report them accurately, ac- cording to Reuters. Also, the report found some physicians and clinicians may not fully understand the importance of specifically citing infections like MRSA in official documen- tation, so they fail to do so. 3. At the state level, accurately tallying drug-resistant in- fections is difficult due to lax legal requirements regarding documentation. Just 17 states require notification of Clos- tridium difficile infections and only 26 states and Washing- ton, D.C., require notifications for MRSA, for example. 4. Even when properly recorded, thousands of nonfatal infections and deaths related to drug-resistant bacteria go uncounted because federal agencies lack the political and financial capabilities necessary to conduct rigorous surveillance. While the numbers gathered by the CDC are regularly cited in news reports and scholarly articles, Reu- ters found the agency's estimates to be based on underre- ported deaths from drug-resistant infections. Michael Craig, the CDC's senior adviser for antibiotic resistance coordination and strategy, told Reuters pressure on the agency from the media and Congress to produce the "big number" resulted in the agency putting forth "an impressionist painting rather than something that is much more technical." The CDC estimates approximately 23,000 people die annually from 17 different types of antibiotic-resistant infections. Additionally, the agency also estimates 15,000 die each year from C. diff. According to Reuters, the actual numbers could be much higher. n

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