Table Of ContentAntibiotic Policies:
Fighting Resistance
Antibiotic Policies:
Fighting Resistance
Edited by
Ian M Gould
Aberdeen Royal Infirmary
Foresterhill, Aberdeen
Australia
and
Jos WM van der Meer
Radboud University
Nijmegen Medical Centre
Nijmegen, The Netherlands
Ian M Gould Jos WM van der Meer
Department of Medical Microbiology Department of General Internal Medicine &
Aberdeen Royal Infirmary Nijmegen University Centre for
Foresterhill, Aberdeen Infectious Diseases
Australia Radboud University
Nijmegen Medical Centre
Nijmegen, The Netherlands
ISBN-13: 978-0-387-70840-9 e-ISBN-13: 978-0-387-70841-6
Library of Congress Control Number: 2007928413
©2008 Springer Science(cid:2)Business Media, LLC.
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Contents
List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
1. Consequences of Antimicrobial Chemotherapy: Overgrowth,
Resistance, and Virulence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Stephanie J. Dancer
2. The Process of Antibiotic Prescribing: Can It Be Changed?. . . . . . . . . 17
Jos W. M. van der Meer and Richard P. T. M. Grol
3. Cultural and Socioeconomic Determinants of Antibiotic Use. . . . . . . . 29
Stephan Harbarth and Dominique L. Monnet
4. Electronic Prescribing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Mical Paul, Roberto Cauda, and Leonard Leibovici
5. Prevalence Surveys of Antimicrobial Use in Hospitals: Purpose,
Practicalities, and Pitfalls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
R. Andrew Seaton
6. Antibiotic Use in Hospitals in the United States SCOPE-MMIT
Antimicrobial Surveillance Network. . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Amy Pakyz and Ron Polk
7. New Hospital Initiatives in Fighting Resistance . . . . . . . . . . . . . . . . . . 93
Fiona Cooke and Alison Holmes
8. Antimicrobial Resistance: Preventable or Inevitable? Problem
of the Era from Two Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Duygu Yazgan Aksoy, Mine Durusu Tanriover, and Serhat Unal
v
vi Contents
9. Fighting Antimicrobial Resistance in the
Mediterranean Region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Michael A. Borg
10. Cystic Fibrosis—Coping with Resistance. . . . . . . . . . . . . . . . . . . . . . . 149
Oana Ciofu and Neils Høiby
11. Community-Acquired Pneumonia—Back to Basics. . . . . . . . . . . . . . . 175
Marc J. M. Bonten and Jan Jelrik Oosterheert
12. Hospital-Acquired Pneumonia: Diagnostic and
Treatment Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Maria V. Torres, Patricia Muñoz, and Emilio Bouza
13. Optimizing Antimicrobial Chemotherapy in the ICU—A Review. . . . 209
Ian M. Gould
14. Risk Assessment for Methicillin-Resistant Staphylococcus
aureus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Evelind Tacconelli
15. What Do We Do with Methicillin-Resistant Staphylococcus
aureusin Surgery?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Giorgio Zanetti
16. Control of Healthcare-Associated Methicillin-Resistant
Staphylococcus aureus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Jan A. J. W. Kluytmans and Bram M. W. Diederen
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Contributors
Duygu Yazgan Aksoy
Department of Medicine, Hacettepe University Faculty of Medicine, Ankara,
Turkey
Marc J. M. Bonten
Department of Internal Medicine and Infectious Diseases, University Medical
Centre, Utrecht, The Netherlands
Michael A. Borg
ARMed Project, St. Luke’s Hospital, Guardamangia, Malta
Emilio Bouza
Department of Clinical Microbiology and Infectious Diseases, Hospital General,
Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
Roberto Cauda
Department of Infectious Disease, Gemelli Hospital, Università Cattolica del
Sacro Cuore Medical School, Rome, Italy
Oana Ciofu
Institute of Medical Microbiology and Immunology, University of Copenhagen,
Copenhagen, Denmark
Fiona Cooke
MRC Clinical Research Training Fellow, Imperial College London, London,
United Kingdom, The Wellcome Trust Sanger Institute, Hinxton, Cambridge,
United Kingdom
Stephanie J. Dancer
Department of Microbiolog, Southern General Hospital, Glasgow, Scotland
vii
viii Contributors
Bram M. W. Diederen
Laboratory of Medical Microbiology and Immunology, St. Elisabeth Hospital,
Tilburg, The Netherlands
Ian M. Gould
Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill,
Aberdeen, Australia
Richard P. T. M. Grol
Department of General Practice, Centre for Quality of Care Research, Radboud
University, Nijmegen, The Netherlands
Stephan Harbarth
Infection Control Program, University Hospitals of Geneva, Geneva, Switzerland
Niels Høiby
Institute of Medical Microbiology and Immunology, University of Copenhagen,
Department of Clinical Microbiology and Danish Cystic Fibrosis Center,
Rigshospitalet, Copenhagen, Denmark
Alison Holmes
Department of Infectious Diseases, Imperial College London and Hammersmith
Hospitals NHS Trust, London, United Kingdom
Jan A. J. W. Kluytmans
Laboratory of Microbiology and Infection Control, Amphia Hospital, Breda,
The Netherlands
Leonard Leibovici
Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah
Tiqwa, Israel, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel
Aviv, Israel
Dominique L. Monnet
National Center for Antimicrobials and Infection Control, Statens Serum Institut,
Copenhagen, Denmark
Patricia Muñoz
Department of Clinical Microbiology and Infectious Diseases, Hospital General
Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
Jan Jelrik Oosterheert
Department of Internal Medicine and Infectious Diseases, University Medical
Centre, Utrecht, The Netherlands
Contributors ix
Amy Pakyz
School of Pharmacy, Department of Pharmacy, Virginia Commonwealth University,
Medical College of Virginia Campus, Richmond, VA, USA
Mical Paul
Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah
Tiqwa, Israel, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel
Aviv, Israel
Ron Polk
School of Pharmacy, Department of Pharmacy, School of Medicine, Department
of Internal Medicine, Virginia Commonwealth University, Medical College of
Virginia Campus, Richmond, VA, USA
R. Andrew Seaton
Infectious Diseases Unit, Brownlee Centre, Gartnavel General Hospital, Glasgow,
Scotland
E. Tacconelli
Department of Infectious Diseases, Catholic University, Rome, Italy, Division of
Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical
School, Boston, MA, USA
Mine Durusu Tanriover
Department of Medicine, Hacettepe University Faculty of Medicine, Ankara,
Turkey
María V. Torres
Department of Clinical Microbiology and Infectious Diseases, Hospital General
Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
Serhat Unal
Department of Medicine, Section of Infectious Diseases, Hacettepe University
Faculty of Medicine, Ankara, Turkey
Jos W. M. van der Meer
Department of General Internal Medicine & Nijmegen University Centre for
Infectious Diseases, Radboud University, Nijmegen Medical Centre, Nijmegen,
The Netherlands
Giorgio Zanetti
Division of Hospital Preventive Medicine and Service of Infectious Diseases,
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Foreword
In 1971, I started a fellowship in infectious diseases and medical microbiology at
the Channing Laboratory of the Harvard Medical Service at Boston City Hospital.
My mentor, Dr. Maxwell Finland, had encouraged me to return there from the
Center for Disease Control (as CDC was known then), where I had studied infec-
tious diseases epidemiology and hospital-associated infection epidemiology, with
the idea that we would review the demographic patterns of bacteremia and several
other infections during Dr. Finland’s long tenure at the hospital. We did so, but
Iwas surprised to find that he also invited me to help with the assessment of the
success or failure of the programs to control antimicrobial use that he and col-
leagues had put into place at the hospital over several years. The paper describing
that review finally was published in 1974, after a long and tortuous process of
review at several journals. Several reviewers felt that such attempts to improve
use amounted to interference with the patient’s physician to do what was best.
Others felt that such programs focused incorrectly on a subject other than treating
the current patient.
Fortunately, today, it is clear that antimicrobial resistance results in major part,
but not entirely, from the ways that we use antimicrobial agents, and that the over-
all interests of patients in general, as well as those of society, are well served by
efforts to use these drugs as well as possible. Many nations have established
rubrics for this, and guidelines on such stewardship now have been published by
professional societies such as the Infectious Diseases Society of America. The
principle, then, now is well-established. The problem remains, however, as to the
best way to accomplish this lofty goal. In the three decades that I have been
involved in looking at this problem, two important guides stand out:
1. All attempts to deal with resistance must be local. The problems of
multidrug-resistant bacteria facing a hospital in Manchester, U.K. may be quite
different than those of a hospital in Manchester, New Hampshire, USA (and, in
fact, may be quite different than those of a hospital just down the street from the
one in Manchester, U.K.). Knowing local patterns of resistance is crucial to selec-
tion of the proper plans to improve antimicrobial use in each local setting.
xi
xii Foreword
2. One size does not fit all. No single dictum or nostrum can be devised that
will deal with the resistance patterns, resources, and other risk determinants for
resistance in every healthcare institution. Rigid national guidelines that work in
all regions do not exist. Rigid regional guidelines that work in all local areas do
not exist. Rigid municipal guidelines that work in all healthcare institutions and
settings in the city do not exist. Instead, efforts should focus as suggested by the
recent guidelines on dealing with multidrug resistant organisms in U.S. health-
care settings from the Centers for Disease Control and Prevention (as CDC is
known now). These recommendations stress that each institution must customize
its own approach to improving drug use, to controlling transmission of resistant
organisms within the institution, and to conducting the surveillance needed to
guide these efforts.
This volume, edited by Ian Gould and Jos van der Meer, appeals to me because
it recognizes these two main principles in its advice to the worker in this field.
The chapters come from many experts in many different countries who work in
many different settings. They focus on practical issues of improving antimicro-
bial use, and consider several tools, old and new, useful in this quest. The authors
speak from experience, as they work in their daily practice on the very issues that
they address. All these features, plus the guiding hands of Drs. Gould and van der
Meer, who have helped us understand these matters for many years, suggest that
the reader will find this new compendium a valuable and practical resource.
The area of improving antimicrobial use is one that will continue to vex us for
many years. However, the goal of such efforts makes the journey worth the fret.
Books such as these make the journey easier.
John McGowan
