title: Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities - United States.
abstract: BACKGROUND
  Treatments for health care-associated infections (HAIs) caused by antibiotic-resistant bacteria and Clostridium difficile are limited, and some patients have developed untreatable infections. Evidence-supported interventions are available, but coordinated approaches to interrupt the spread of HAIs could have a greater impact on reversing the increasing incidence of these infections than independent facility-based program efforts.
  
  
  METHODS
  Data from CDC's National Healthcare Safety Network and Emerging Infections Program were analyzed to project the number of health care-associated infections from antibiotic-resistant bacteria or C. difficile both with and without a large scale national intervention that would include interrupting transmission and improved antibiotic stewardship. As an example, the impact of reducing transmission of one antibiotic-resistant infection (carbapenem-resistant Enterobacteriaceae [CRE]) on cumulative prevalence and number of HAI transmission events within interconnected groups of health care facilities was modeled using two distinct approaches, a large scale and a smaller scale health care network.
  
  
  RESULTS
  Immediate nationwide infection control and antibiotic stewardship interventions, over 5 years, could avert an estimated 619,000 HAIs resulting from CRE, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. difficile. Compared with independent efforts, a coordinated response to prevent CRE spread across a group of inter-connected health care facilities resulted in a cumulative 74% reduction in acquisitions over 5 years in a 10-facility network model, and 55% reduction over 15 years in a 102-facility network model.
  
  
  CONCLUSIONS
  With effective action now, more than half a million antibiotic-resistant health care-associated infections could be prevented over 5 years. Models representing both large and small groups of interconnected health care facilities illustrate that a coordinated approach to interrupting transmission is more effective than historical independent facilitybased efforts.
  
  
  CONCLUSIONS
  Public health-led coordinated prevention approaches have the potential to more completely address the emergence and dissemination of these antibiotic-resistant organisms and C. difficile than independent facility-based efforts.
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Slayton
authors.forename: Damon
authors.initials: D
authors.lastname: Toth
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.forename: Windy
authors.initials: W
authors.lastname: Tanner
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Bartsch
authors.forename: Karim
authors.initials: K
authors.lastname: Khader
authors.forename: Kim
authors.initials: K
authors.lastname: Wong
authors.forename: Kevin
authors.initials: K
authors.lastname: Brown
authors.forename: James A
authors.initials: JA
authors.lastname: McKinnell
authors.forename: William
authors.initials: W
authors.lastname: Ray
authors.forename: Loren G
authors.initials: LG
authors.lastname: Miller
authors.forename: Michael
authors.initials: M
authors.lastname: Rubin
authors.forename: Diane S
authors.initials: DS
authors.lastname: Kim
authors.forename: Fred
authors.initials: F
authors.lastname: Adler
authors.forename: Chenghua
authors.initials: C
authors.lastname: Cao
authors.forename: Lacey
authors.initials: L
authors.lastname: Avery
authors.forename: Nathan T B
authors.initials: NT
authors.lastname: Stone
authors.forename: Alexander
authors.initials: A
authors.lastname: Kallen
authors.forename: Matthew
authors.initials: M
authors.lastname: Samore
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
authors.forename: Scott
authors.initials: S
authors.lastname: Fridkin
authors.forename: John A
authors.initials: JA
authors.lastname: Jernigan
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001419:Bacteria / Q000187:drug effects*; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D016360:Clostridioides difficile / Q000187:drug effects; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial; D006268:Health Facilities; D006801:Humans; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents