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Antibiotic resistance is increasing, with no signs of abatement. Antibiotic-resistant microorganisms, such as methicillin-resistant Staphylococcus aureus and multidrug-resistant Streptococcus pneumoniae, reside in most hospitals and long-term care facilities, resulting in an unprecedented number of costly, often fatal infections. The National Institute of Allergy and Infectious Diseases has reported that about 2 million patients in the United States acquire nosocomial infections annually; of these, about 90,000 die as a result-an almost sevenfold increase from the number of deaths so attributed in 1992. Of the bacterial strains that can cause nosocomial infections, more than 70% have developed resistance to one or more of the antibiotics commonly used to treat them. Nor are such organisms limited to inpatient and residential facilities. They develop and reside in people who consume antibiotics, whenever and wherever these drugs are used; once present in the community, they spread readily from person to person.
Many agencies and organizations, including the Centers for Disease Control and Prevention (CDC) and the World Health Organization, have recognized antibiotic resistance as one of the most pressing public health issues of our time. This has resulted in massive surveillance and research efforts, particularly in the area of antibiotic overuse. In an article published in the September 17, 1997, issue of the Journal of the American Medical Association (JAMA), Gonzales and colleagues estimated that among U.S. adults, 50% to 70% of office visits for the treatment of colds, upper respiratory tract infections, and bronchitis resulted in antibiotic prescription-even though more than 90% of such illnesses are viral in origin. In the March 18, 1998, issue of JAMA, Nyquist and colleagues reported similar antibiotic prescription rates (44% to 75%) for children with these illnesses. More recent studies also support these findings.
Nurses have been largely absent from educational and research efforts.
As a researcher and clinician, I'm excited by current research on the appropriate use of antibiotics. But my excitement is tempered by the knowledge that nurses have been largely absent from relevant educational and research efforts. Although advanced practice nurses frequently receive continuing education concerning appropriate antibiotic use, most nurses do not. Their exposure to the subject is limited to public service announcements and the lay literature, inadequate sources for any practicing professional.
According to the ANA's Code of Ethics for Nurses with Interpretive Statements (http://www.ana.org/ethics/code/protected_nwcoe303.htm), nurses have a responsibility to protect the health not only of individuals but also of the public. Perhaps we've underestimated what that responsibility entails. Caring for patients in daily practice, the nurse can become immersed in the "here and now"-sometimes to the extent that perspective is lost and certain health issues begin to seem unrelated or peripheral to the nurse's practice.
A colleague and I recently conducted a qualitative study examining nurses' experiences of antibiotic use, overuse, and resistance. I was struck by the number of nurses who declined participation, stating that they weren't affected by these phenomena because they weren't directly involved in administering or counseling patients on antibiotics. Perhaps this perception is why, at the CDC's 2005 Conference on Antimicrobial Resistance Programs, the identified target audience of most of the clinical presentations included physicians, physician assistants, pharmacists, and NPs-but not nurses who don't happen to be NPs.
Antibiotic resistance affects everyone. It affects nurses in all settings and all aspects of nursing, from administration to education. What might happen if nurses took a more active role in education and research on appropriate antibiotic use and the problems of overuse and resistance? I have no doubt we would witness an impressive drop in antibiotic use and ultimately, in the number of antibiotic-resistant infections. For more information, visit http://www.cdc.gov/getsmart.
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