infection prevention and control – Alabama Regional Center for Infection Prevention & Control, Training and Technical Assistance (ARCIPC)

Antimicrobial Resistance and Multi-Drug Resistant Organism in Hospitals and Long-Term Care Facilities

Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. Resistant infections can be difficult, and sometimes impossible to treat. Multidrug-resistant organisms are bacteria’s that have become resistant to certain antibiotics, and these antibiotics can no longer be used to control or kill the bacteria. Antibiotics are important medicines. They help fight infections that are caused by bacteria. Bacteria that resist treatment with more than one antibiotic are called multidrug-resistant organisms (MDROs for short), (ct.gov,2023).

Examples of (MDROs), includes methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and certain gram-negative bacilli (GNB) which have important infection control implications that either have not been addressed or received only limited consideration (CDC,2015).

Below are recommended resources for hospitals and long-term care facilities on MDROs:

ANTIMICROBIAL RESISTANCE

The Changing Landscape of Antimicrobial Resistance Following the COVID-19 Pandemic

MULTI DRUG-RESISTANT ORGANISMS (MDROs)

General information about MDROs: What are they?

General Recommendations for Routine Prevention and Control of MDROs in Healthcare Settings

Preventing the Spread of Novel or Targeted Multidrug-resistant Organisms (MDROs)

Infection Prevention of MDROs in Long-Term Care Settings

Candida auris: A multi-drug resistant pathogen

Candida auris is an emerging pathogen that results in nosocomial infections and is considered a serious global health problem. It was first observed as a novel Candida species in 2009 and has been isolated in 35 countries.

C. auris may cause invasive infections associated with high mortality. It is considered a multi-drug resistant species, having variable resistance patterns to many typical antifungal agents used to treat other Candida infections.

The CDC is concerned about C. auris for three main reasons:

It is often multidrug-resistant, meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections. Some strains are resistant to all three available classes of antifungals.
It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.
It has caused outbreaks in healthcare settings. For this reason, it is important to quickly identify C. auris in a hospitalized patient so that healthcare facilities can take special precautions to stop its spread.

Candida Auris: What is it? Can we stop it? | ARC IPC

Resources for Candida auris:

General Information:

Centers for Disease Control and Prevention – https://www.cdc.gov/fungal/candida-auris/candida-auris-qanda.html
Multi-lingual fact sheets on Candida auris by the CDC: contains information on Candida auris.what we need to know, cases over time and global threat of the disease in languages such as English, Spanish, Vietnamese, Korean and Haitian – Candida auris: A multi-drug resistant pathogen

Infection Prevention:

Infection Prevention and Control for Candida auris: contains infection prevention guidelines and transmission based precaution – https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html
Candida Auris toolkit: This toolkit includes a set of resources that your facility can utilize to detect, manage and control Candida auris and to communicate C. auris information to other healthcare providers, patients and families – https://hip.phila.gov/disease-control/healthcare-associated-infections-antibiotic-resistance/candida-auris-toolkit/
National Notifiable Disease Surveillance system tracking as per number of cases by state in the U.S – https://www.cdc.gov/fungal/candida-auris/fact-sheets/index.html
Strategies to Prevent Transmission of Candida auris in Healthcare Settings – https://link.springer.com/article/10.1007/s12281-023-00451-7

For Healthcare Providers:

Treatment and management of Candida auris infection and colonization – https://www.cdc.gov/fungal/candida-auris/c-auris-treatment.html

Webinars

What You Should Know About the 2022 Monkeypox Outbreak

From early May 2022 to June 13, 2022 (the date of this podcast recording), over 1,300 confirmed cases of monkeypox have been reported across 31 countries that normally don’t see any cases of monkeypox. Occasionally, outbreaks have occurred outside Africa. But, in most instances, these cases were associated with international travel or contact with individuals or animals from endemic regions. Currently, the CDC and World Health Organization are tracking multiple reported cases and monitoring several person in counties without endemic monkeypox and with no known travel links to an endemic area.

In today’s podcast, we welcome back Dr. Rachael Lee, Associate Professor in the UAB Division of Infectious Diseases and UAB Health Epidemiologist to talk to us about monkeypox – what it is and if we should be worried?

Thank you to our co-sponsor for this podcast, the Alabama Public Health Training Network at the Alabama Department of Public Health a community-based training partner of the Region IV Public Health Training Center.

Further Reading:

ADPH Resources – https://www.alabamapublichealth.gov/monkeypox/resources.html
CDC 2022 Monkeypox and Orthopoxvirus Outbreak Global Map – https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html
CDC 2022 U.S. Monkeypox Cases – https://www.cdc.gov/poxvirus/monkeypox/index.html
World Health Organization – https://www.who.int/health-topics/monkeypox

For Healthcare Providers:

CDC – Information for Healthcare Providers – https://www.cdc.gov/poxvirus/monkeypox/clinicians/index.html
CDC – Updated Case-finding Guidance: Monkeypox Outbreak—United States, 2022 – https://emergency.cdc.gov/han/2022/han00468.asp (6.14.22)

News Articles:

AP: UK reports 104 more cases of monkeypox, mostly in men – https://apnews.com/article/health-united-nations-england-world-organization-2d45ed6078895dd6a012a1b3555ee3b5 (6.13.22 Published)
Centers for Infectious Disease Research and Policy – https://www.cidrap.umn.edu/news-perspective/2022/06/uk-reports-194-more-monkeypox-cases-us-total-hits-49 (6.13.22 Published)

Hepatitis Outbreak in Children

Figure 1: “States and Jurisdictions Reporting at Least One Person Under Investigation (38)* as of June 1, 2022.” CDC

The State of Alabama has had a lot of firsts; the first open-heart surgery in the Western Hemisphere was performed in Montgomery in 1902, in 1968 the first 911 call was placed from Haleyville, AL, and unfortunately in 2021 amid the ongoing COVID-19 pandemic Alabama identified their first case of a new Hepatitis outbreak among children under the age of 10. Children in Alabama began to fall ill with symptoms of Hepatitis, an inflammation of the liver that can cause jaundice, fever, fatigue, nausea, vomiting, joint pain, and more symptoms. Despite the mysterious onset and widespread unconnected cases under investigation doctors and other researchers are still trying to pin down the direct cause. The onset of symptoms has not been shown to be related to COVID-19 or its vaccinations, as once thought could be the case. Now, research points to the outbreak possibly being related to a new adenovirus strain. As of June 1, 2022, the outbreak and cause are still under investigation, with 246 cases under investigation of children under the age of ten showing symptoms of hepatitis with an unknown cause across 38 different states with 6 deaths since October 2021. Unfortunately, as is frequently the case with outbreaks, cases have been seen beyond the borders of Alabama or the United States where it started, with cases of hepatitis with an unknown cause among children being reported across the globe with roughly 650 cases spread across 33 different countries. Doctors and researchers are working to determine the cause of the outbreak in order to curb the case count, but until then check out our podcast and the resources below to help you stay informed on the latest happenings in Infection Prevention and Control.

Listen to a podcast from Dr. Wes Stubblefield, District Medical Officer for the Northern and Northeastern Public Health Districts at the Alabama Department of Public Health on this recent outbreak of pediatric hepatitis.