COCA Now: Containing Unusual Resistance - Early, aggressive action can prevent spread

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CDC Vital Signs Report:

Containing Unusual Resistance

Early, aggressive action can prevent spread

CDC Vital Signs Graphic

CDC’s most recent Vital Signs report highlights the importance of rapid identification of new or rare resistance. This is the critical first step in CDC’s Containment Strategy to stop the spread of antibiotic resistance (AR). Once AR spreads, it is harder to control. Finding and responding to unusual resistance early, before it becomes common, can help stop its spread and protect people.

Germs with unusual resistance include those that cannot be killed by all or most antibiotics, and are uncommon in a geographic area or the U.S., or have specific genes that allow them to spread their resistance to other germs.

Health departments working with CDC’s AR Lab Network found more than 220 instances of germs with unusual AR genes in the U.S. last year, according to the CDC Vital Signs report released today. To stop spread of threats like these, the CDC Containment Strategy calls for

  • rapid identification of unusual resistance, 
  • infection control assessments, 
  • testing (screening) patients without symptoms who may carry and spread the germ, 
  • a coordinated response with other health care facilities, and
  • continued infection control assessments and screenings until spread is stopped.

Health departments using the approach have conducted infection control assessments and colonization screenings within 48 hours of finding unusual resistance, and have reported no further transmission during follow-up over several weeks. New data suggest that the Containment Strategy can prevent thousands of difficult-to-treat or potentially untreatable infections, such as those caused by high-priority threats such as carbapenem-resistant Enterobacteriaceae (CRE).

The strategy complements other CDC efforts, including improving antibiotic use and preventing new infections, and builds on existing detection and response infrastructure.

Join the April Vital Signs Town Hall on Tuesday April 10 from 2-3PM (ET) to learn more about the Containment Strategy. 

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Overview

More than 23,000 Americans die each year from infections caused by germs resistant to antibiotics. While antibiotic resistance (AR) threats vary nationwide, AR has been found in every state. And unusual resistance germs, which are resistant to all or most antibiotics tested and are uncommon or carry special resistance genes, are constantly developing and spreading. Lab tests uncovered unusual resistance more than 200 times in 2017 in "nightmare bacteria" alone. With new resources nationwide, early and aggressive action--even when a single case is found--can keep germs with unusual resistance from spreading in health care facilities and causing hard-to-treat or even untreatable infections. For example, CDC estimates show that this aggressive approach could prevent 1,600 cases of carbapenem-resistant Enterobacteriaceae (CRE) in one state over three years. Health departments can lead the Containment Strategy and act swiftly with health care facilities and CDC at the first sign of unusual resistance.

What can be done?

The Federal Government is:

  • Monitoring resistance and sounding the alarm when threats emerge. CDC develops and provides new lab tests so health departments can quickly identify new threats.
  • Improving identification through CDC’s new AR Lab Network in all 50 states, 5 large cities, and Puerto Rico, including 7 regional labs and a national tuberculosis lab for specialty testing.
  • Supporting prevention experts and programs in every state, and providing data and recommendations for local prevention and response.
  • Testing innovative infection control and prevention strategies with health care and academic partners.

State and Local Health Departments and Labs can:

  • Make sure all health care facilities know what state and local lab support is available and what isolates (pure samples of a germ) to send for testing. Develop a plan to respond rapidly to unusual genes and germs when they first appear.
  • Assess the quality and consistency of infection control in health care facilities across the state, especially in facilities with high-risk patients and long stays. Help improve practices.
  • Coordinate with affected health care facilities, the new AR Lab Network regional lab, and CDC for every case of unusual resistance. Investigations should include onsite infection control assessments to find spread. Consider colonization screenings. Continue until spread is controlled.
  • Provide timely lab results and recommendations to affected health care facilities and providers. If the patient came from or was transferred to another facility, alert that facility.
  • Find resources: www.cdc.gov/hai/outbreaks/mdro

Health Care Facilities can:

  • Plan for unusual resistance arriving in your facility. Find resources: www.cdc.gov/hai/outbreaks/mdro
  • Leadership: Work with the health department to stop spread of unusual resistance. Review and support infection control in the facility.
  • Clinical labs: Know what isolates to send for testing. Establish protocols that immediately notify the health department, health care provider, and infection control staff of unusual resistance. Validate new tests to identify the latest threats. If needed, use isolates from wwwn.cdc.gov/arisolatebank/.
  • Healthcare providers, epidemiologists, and infection control staff: Place patients with unusual resistance on contact precautions, assess and enhance infection control, and work with the health department to screen others. Communicate about status when patients are transferred. Continue infection control assessments and colonization screenings until spread is controlled. Ask about any recent travel or health care to identify at-risk patients.

To read more about the containment strategy and the full MMWR early release article from April 3, 2018, click here.

To read the Vital Signs factsheet, click here.