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Letter
Addressing the at-home care needs of patients with multidrug-resistant bacteria: what should we do?
  1. Ana Isabel Cachafeiro Pin1,
  2. Laura Villaverde Piñeiro2
  1. 1 Pharmacy, Hospital Da Costa, Burela, Galicia, Spain
  2. 2 Pharmacy, Hospital Comarcal de Monforte, Monforte de Lemos, Spain
  1. Correspondence to Ana Isabel Cachafeiro Pin, PHARMACY, Hospital Da Mariña, Burela, Galicia, Spain; ana.isabel.cachafeiro.pin{at}sergas.es

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Among healthcare-related infections (HCRI), those caused by multidrug-resistant (MDR) bacteria are a major problem today. According to the O’Neill report,1 if this situation were to continue the number of deaths would increase from 700 000 to 10 million per year by 2050, even surpassing deaths from cancer. Klebsiella pneumoniae was responsible for 2–5% of HCRI in Spain between 2011 and 2014 and accounts for almost 8% at present.2 Recently, a global prevalence study found it is the most frequently isolated pathogen in ICUs (5–10%). High resistance percentages (close to 50%) have been observed for third-generation cephalosporins, penicillins associated with beta-lactamase and quinolone inhibitors and increased resistance to carbapenems. Transfer between people occurs primarily via the hands of the personnel responsible for patient care. The bacterium is found colonising the intestine and perineal area and its presence is very frequent in ulcers and urinary catheters, hence its involvement in outbreaks at health centres, since they are one of the main reservoirs of multidrug-resistant micro-organisms.3 Healthcare in these settings poses a major challenge in controlling the transmission of infections. Preventive measures have been established, including standard and extended precautions, antimicrobial stewardship (AMS) programmes, education of residents and family members and hygiene visits, among others.

However, we should ask: What happens to patients with MDR bacteria at home and how and when do we educate patients and their families and/or caregivers about the guidelines to follow? Who monitors their care and answers questions about at-home management? To achieve quality healthcare, it is essential not to lose sight of the suffering, pain, disability and reduced quality of life resulting from HCRI in both patients and the immediate environment. We lack standardised protocols that effectively integrate patients as members of the care team and make them agents for their own safety. Given that up to half of healthcare-related infections are preventable,4 health professionals have an essential role to play in minimising their transmissibility, mainly by improving our adherence to hand hygiene. We also need to provide education and training to family members and/or carers on hand hygiene, proper use of gloves, how to establish isolation and other measures to prevent spread to the rest of the family. It would also be interesting to designate a reference health professional within the hospital AMS team5 who would coordinate the follow-up of other professionals (including primary care) and to whom questions concerning antibiotic treatment, decontamination guidelines and the taking of new control samples could be referred. Only in this manner, by improving communication and providing a real response and support to their needs, will we be able to improve the quality of life of patients and their families.

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Footnotes

  • Twitter @anaicp, @lvilpin1

  • Contributors AICP and LVP designed the study and made primary contributions to data collection and assisted with data collection. All authors contributed to interpretation of results and revision of manuscript, and all approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.