SUPERBUGS: STRUMENTI DI INTERVENTO
NELL’ERA POST-ANTIBIOTICA
Nicola Petrosillo
Dipartimento Clinico e di Ricerca in Malattie Infettive
INMI «L. Spallanzani», IRCCS - Roma
Emerging Threats in Healthcare
MDR organisms in the healthcare setting: from ESKAPE to
ESCAPE
•
We are currently facing new microbiological,
infection control and clinical issues, and the
epidemiologic variations observed in the last
years highlighted the need of a change from the
initial proposed acronym:
• “ESKAPE”
E. faecium
S. aureus
K. pneumoniae

A. baumannii
P. aeruginosa
Enterobacter species
“ESCAPE”
E. faecium
S. aureus
C. difficile
A. baumannii
P. aeruginosa
Enterobacteriaceae
Euro Surveill 2013; 18:46
ECDC/EMA: European Annual Cost Estimates
of Five Top MDRB
Hospital and Societal Costs of
Antimicrobial-Resistant Infections
(ARIs)
An economic analysis of the
Chicago Antimicrobial Resistant Project
dataset:
188 / 1391 patients (13.5%) with ARI
Medical costs
attributable to ARI
Excess LOS
Attributable mortality
Societal costs
$18,588 - $29,069 / patient
6.4 – 12.7 days
6.5%
$10.7 - $15.0 million
Roberts RR et al. Clin Infect Dis 2009;49:1175-84.
•
-
Less surgery for the risk of AMR
Caesarean sections contribute about 2% to world GDP
Joint replacements add about 0.65%
Organ transplant add about 0.1%
• These are just a small number of the areas in modern
medicine that risk being undermined if we do not have
effective antibiotics in the future
• Concerns for international travels less trade affecting
mainly developping countries
Estimates of Preventable
Estimates
of preventable
infections,
deaths,
and
Infections,
Deaths,
and
Costs
costs based on existing published literature
Infection
type
Preventable
fraction
Preventable
infections
(thousands)
Preventable
deaths
(thousands)
Cost avoided
(millions of 2009
dollars)
CLABSI
18%–66%
45-164
6-20
$960-$18,200
VAP
38%–55%
95–138
14–20
$2,200-3,300
CAUTI
17%–69%
95–388
2–9
$115-$1,820
SSI
26%–54%
75–157
2–4
$166-$345
Source: Umschied, C. University of Pennsylvania. Presentation at HICPAC, March 2009
Antimicrobial Stewardship Programs
ASPs are designed
•to optimize antimicrobial therapy,
1-to improve patients’ outcomes,
2-ensure cost-effective therapy and
3-reduce adverse effects associated with
antimicrobial use, including antimicrobial
resistance and C difficile occurrence
INFECTION CONTROL AND ANTIBIOTIC STEWARDSHIP
Although the responsibilities of antimicrobial
stewardship programs and infection control
departments are different, collaboration
between these groups is essential in
•promoting optimal outcomes,
•providing cost-effective care,
•reducing the development of resistance, and
•preventing the spread of infection.
•Infection control departments must rely on
stewardship programs to help minimize excessive
antibiotic exposure, which ultimately decreases
the level of risk that patients face with regard
to acquiring infections due to multidrugresistant organisms.
•Antimicrobial stewardship programs rely on good
infection-control practices, in a complementary fashion,
to minimize the patient-to-patient spread of multidrug
resistant bacteria.
•Poor infection control practices can lead to increasing
number of patients with multidrug-resistant infections,
which leads to a downward spiral of increased utilization
of broad-spectrum antibiotics and the further
development of resistance.
Additionally, antimicrobial stewardship programs
and infection control practitioners are well
positioned to identify and improve patient
outcomes linked to a specific disease because
they already target patients with specific
infections, disease states, or patients receiving
certain antimicrobials.
Interactions between ASP and IC professionals
•Drug-based antimicrobial stewardship
•Disease-based antimicrobial stewardship and multidisciplinary
bundle
•Device-associated Infection Prevention
•Barriers to implementation and maintenance of stewardship
programs
•Making a business case for antimicrobial stewardship
•Measuring the impact of the Program
From competence to meta-competence
Thera-py
Antimicrobial Stewardship (A-Teams)
ID-doctor
Intensivist
Pharmacist
Clin. Microbiol.
ABS
Clin. Microbiol
- infection prevention
PHS
Moleculair
Medisch Microbioloog
Infection Control
Practitioner
Dia-gnostic
Stewardship
Courtesy Prof. A Friedrich
Dik et al. 2015 Future Microbiology
Infection
Prevention
Stewardship