(CDC, 2017a)

Who is affected? Where?
Antibiotic resistant infections can affect anyone from pediatrics to geriatrics; including those in the outpatient setting (doctors offices), nursing homes, those in the hospital setting and even in the community (CDC, 2017b).

How does antibiotic resistance happen?
Antibiotic resistance can develop from even one bacterium becoming resistant to antibiotics, which can then multiply and replace all bacteria that were destroyed, thus further making those surviving bacteria resistant to future antibiotics leading to the development of infections (CDC, 2017a).

(CDC, 2017a)

What causes the spread of infection?
Unnecessary antibiotic use; misuse or through person to person transmission via: contact with contaminated hands of hospital staff, contact with contaminated surfaces such as door handles, over the bed tables, furniture, call bells and contact with contaminated equipment such as stethoscopes and blood pressure cuffs. This can occur in both inpatient and in outpatient settings (Victoria State Government, 2017). 
 

A systematic review of studies showed evidence that the administration of probiotics closer to the first dose of antibiotics reduces the risk of antibiotic associated c-diff infections by over 50% in hospitalized adults (Ancy, Crawford, Evans, Maw, Pino, Shen, Simon & Tmanova, 2017).   

Probiotics add good bacteria to the digestive system. They don't effect the antibiotic treatment, they only treat the side effects. Probiotics can come in supplemental pill form or from everyday foods we eat. For example, yogurt that contains "active and live cultures" are a great source of probiotics that can be implemented into a persons diet (Cleveland Clinic, 2015). 

A study conducted in a Pennsylvania hospital showed that patients on antibiotics  who were given 2 cups a day of yogurt (already available at the hospital), had a dramatic decrease in c-diff infections acquired in the hospital setting (ACP Hospitalist, 2014).

As nurses, we can use this EBP and recommend to the doctor to prescribe the patients probiotics or the doctor can make suggestions of OTC probiotic supplements to patients receiving antibiotic treatment to help prevent antibiotic resistant associated diarrhea when applicable. Nurses can use this EBP and recommend/advocate for the patients to consume yogurt with active and live cultures as part of the patients dietary meal plans to help prevent occurrence of c-diff infections both in the hospital setting and outpatient. Yogurt may also be a more cost effective means of introducing good bacteria as opposed to supplementation. 

The American Nurses Association suggests five ways to help prevent future emergence of antibiotic resistance through the influence of antibiotic management decisions:

1. Ensure pertinent information about antibiotics is available at the point of care
-all healthcare team members should have access to key information about a patients antibiotic therapy to help influence antibiotic management decisions.

2. Question the antibiotic route of administration
-Advocating: PO vs. IV route

3. Reassess antibiotic therapy in 2-3 days
-broad spectrum antibiotic use vs. narrow-spectrum

4. Review antibiotic therapy when your patient develops new c-diff infections
-are the antibiotics still indicated at this point?

5. Review antibiotics during all patient care transitions
-re-evaluate antibiotic use between care settings such as hospitals and outpatient as well as between different care points in the facility (ICU floor to step down).

(American Nurse Today, 2016)


Nurses should also emphasis patient education with antibiotic use in the outpatient setting:

(WHO, 2017)