Antibiotic Resistance—an Alarming Health Care Issue - Statistical Data Included

AORN Journal, July, 2000 by Carolyn Twomey

The CDC National Nosocomial Infections Surveillance (NNIS) system indicates that surgical site infections (SSIs) are the third most frequently reported nosocomial infection, accounting for 14% to 16% of all nosocomial infections among hospitalized patients.(13) Between 1986 and 1996, SSIs were the most common nosocomial infection found in surgical patients, accounting for 38% of all infections. Of these reported SSIs, two-thirds were confined to the incision, and one-third involved organs or spaces (eg, disc spaces, oral cavities, dural spaces, arteries, veins) accessed during procedures. Seventy-seven percent of patients' deaths were related to infection, and the majority (ie, 93%) were related to serious infection involving organs or spaces accessed during procedures.

In one study, researchers compared the lengths of stays of patients who developed nosocomial surgical wound infections to the lengths of stay of the general surgical population.(14) Between Jan 1, 1990, and Aug 1, 1992--a study period of 19 months--the average length of stay for patients who developed infected surgical wounds was 14.5 days. Patients who did not develop infections spent an average of 4.7 days in the hospital. The mean attributable difference in lengths of stays between these two groups was 5.3 days. This study found nosocomial surgical wound infections added 2,061 inpatient days during the study period--a $1.9 million cost to the facility.

According to these researchers, 500,000 to one million of the 23 million surgical procedures performed annually in the United States result in surgical wound infections. Nosocomial wound infections have a significant negative human and financial impact. Despite advances in OR ventilation, availability of antimicrobial prophylaxis, sterilization methods, surgical technique, and barriers--especially surgical gloves--SSIs continue to be a significant cause of patient morbidity and mortality.

EMERGING MICROBES

Resistant microbes have emerged in response to various conditions and opportunities. Their growth has been encouraged by multimedication prophylaxis, new surgical procedures of longer duration and greater risk (eg, organ transplantations), the use of indwelling devices, hospitalization of immune-suppressed or immune-compromised patients, serious acute disease or chronic illness in older adult patients, and breakdown in aseptic technique. Community factors, such as clustering and overcrowding, population mobility, and inadequate sanitation, have conspired to give pathogens an evolutionary edge.(15) In the major categories of bacteria responsible for this emergence of resistance, three factors are striking.

* The increased frequency of vancomycin use.

* The increased use of temporary indwelling catheters in patients who are critically ill. One researcher examined the relationship of bacteremia to invasive line status and found that, although there was an enormous range of infections, the number of bloodstream infections per central venous catheter (CVC) use was dramatically higher than the number of infections per nonCVC use.(16)