Long-term acute care hospitals (LTACs), which cater to chronically ill patients with multiple co-morbidities and prolonged stays, have been suggested to act as reservoirs for multi-drug resistant organisms (MDROs) – making them of particular interest for surveillance and monitoring.
At ASM Microbe, the annual meeting of the American Society for Microbiology (7–11 June, GA, USA), we spoke to infectious diseases specialist, Ellie Goldstein (Santa Monica, CA, USA), about his recent publication on this issue and the challenges facing drug-resistant infections.
First, could you introduce yourself and tell us a bit about your background?
My name is Ellie Goldstein, I’m an infectious disease physician and I do many different things; I’m a Clinical Professor of Medicine at the University of California, Los Angeles, I’m Director of the RM Alden Research Laboratory (Santa Monica, CA, USA), which is an anaerobic research lab, I am in clinical practice and I’m involved in antimicrobial stewardship.
You recently published a paper on the comparative ‘real world’ in vitro activity of two new antimicrobials – why do you think ‘real world’ data is important?
What we find is that much of the work done on antimicrobials susceptibility testing is done by laboratories that collect selected resistant isolates, from universities with special care units, or come from the selected studies that lead to licensure. These take into account various groups of patients but they can’t give any information on what’s happening in a local institution who face community real life problems. So, while we can make generalizations from these studies, when new drugs are released it’s important that we study what is happening at a single institution with a wide catchment referral base and evaluate how this can help physicians guide specific therapies for these patients.
LTACs are a particularly important place to evaluate new antibiotics because LTAC patients often move between different healthcare facilities and carry their resistant organisms with them. Approximately 50% of short-term acute care hospital patients who have CREs are ultimately discharged to LTACs – so LTACs are thought to be reservoirs for resistance. By carrying out this study we hoped to understand how we could best guide therapy for our patients.