Reducing Antimicrobial Resistance and Hospital-Associated Infections: The Role of the Hospitalist

Third, curbing antimicrobial overuse can be fostered by avoiding treatment of contamination or colonization. Contaminated cultures may be reduced by using and advocating proper antisepsis for blood cultures and other culture specimens. Recognition of organisms unlikely to represent true bacteremia (e.g., Corynebacterium), as well as those very likely to represent true bacteremia (e.g., Staphylococcus aureus or Entero-bacteriaceae), and interpreting culture results within clinical context help clinicians effectively treat positive cultures when indicated and avoid treating contaminants. Additionally, recognizing when cultures from urinary catheters, intravascular catheters, and endotracheal tubes represent colonization rather than infection and taking active steps to obtain accurate (rather than colonized) cultures can further curb nonindicated antibiotic use. For example, routinely sending catheter tips for culture is not indicated. Also, urinalysis should always accompany urine cultures sent from urinary catheters. Fourth, stopping antimicrobial therapy when infections are cured, cultures are negative and infection unlikely, or when infection is not diagnosed also limits antimicrobial overuse.

Finally, prevention of infection transmission from patient to patient or from healthcare worker to patient can be accomplished by use of standard infection control precautions, use of appropriate isolation precautions and handling of bodily fluids, and accessing infection control experts when questions arise. Frequent and effective hand hygiene as well as empowering all hospital staff to take part in and enforce infection control measures will help reduce transmission of infection by healthcare personnel.

In summary, antimicrobial resistance and hospital-acquired infections represent an enormous issue for patients, providers, hospitals, and the public. Hospitalists are positioned to take a large role in improving patient safety by supporting, following, and advocating the recommended guidelines and evidence-based measures to reduce the incidence of hospital-acquired infections at the local and national levels. Great investment of time, resources, and efforts in quality-improvement initiatives are necessary to reduce resistance, reduce infection, and improve overall outcomes for our patients.

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