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Control of aminoglycoside resistance by barrier precautions
Abstract:
The efficacy of antibiotic resistance (barrier) precautions for control of aminoglycoside resistance was evaluated from 1978 to 1981. Despite increasing aminoglycoside use and a 13-fold increase in aminoglycoside-resistant isolates on a newly opened oncology unit, the hospital-wide frequency of aminoglycoside resistant Enterobacteriaceae remained low, supporting the continued value of barrier precautions which were initiated in our hospital in 1974. This control enabled us to focus on exceptions to the effectiveness of barrier precautions. These were traced to environmental reservoirs, very chronic and heavily infected patients, asymptomatic carriers of Serratia, and oncology patients receiving oral non-absorbable aminoglycosides. In addition, resistance in Pseudomonas aeruginosa paralleled aminoglycoside use and, as in our prior experience, continued to rise. With increasing adoption of barrier precautions by others such exceptions should be anticipated.
Insights
Barrier precautions effectively controlled aminoglycoside resistance in hospitals despite increased antibiotic use. Exceptions were identified in specific patient groups and environmental factors, highlighting areas for focused infection control strategies.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Stewardship
Background:
- Aminoglycoside resistance poses a significant threat to effective antibiotic therapy.
- Hospital-wide implementation of barrier precautions began in 1974 to combat antimicrobial resistance.
Purpose of the Study:
- To evaluate the long-term efficacy of barrier precautions in controlling aminoglycoside resistance.
- To identify specific circumstances and patient populations where barrier precautions may be less effective.
Main Methods:
- Retrospective evaluation of antibiotic resistance data from 1978 to 1981.
- Analysis of aminoglycoside use patterns and resistant bacterial isolate frequencies.
- Investigation of exceptions to the effectiveness of barrier precautions.
Main Results:
- Hospital-wide aminoglycoside-resistant Enterobacteriaceae remained low, supporting barrier precaution efficacy.
- A 13-fold increase in aminoglycoside-resistant isolates was observed on a new oncology unit.
- Exceptions were linked to environmental reservoirs, chronic infections, asymptomatic carriers, and oral non-absorbable aminoglycosides.
Conclusions:
- Barrier precautions remain a valuable strategy for controlling hospital-wide aminoglycoside resistance.
- Specific patient populations and environmental factors require targeted interventions to overcome resistance.
- Anticipating and addressing exceptions is crucial for comprehensive infection control.