Quality of life in patients with moderate and severe infections

The fight against AMR and counteracting strategies 

The causes of antimicrobial resistance (AMR) often include the misuse and overuse of antibiotics which, over time, has led to bacterial resistance⁽¹⁾ and the need to develop new molecules to fight an increasingly alarming problem.⁽²⁾ In fact, the World Health Organization (WHO) is engaged in the fight against AMR, which is considered one of the most serious public health threats in the twenty-first century. ⁽³⁾

In 2021 the ECDC (European Center for Disease Prevention and Control) published its annual report based on data provided by the European Antimicrobial Resistance Surveillance Network (EARS-Net), a network that collects data from 29 European Union and European Economic Area (EU/EEA) countries selected for their clinical and microbiological importance.

The document highlighted a rather diverse situation at European level; in fact, antibiotic resistance shows major variations as regards the bacteria, antimicrobial group and geographical region. This variability is probably due to differences in antibiotic use, infection and prevention control methods, and healthcare delivery systems.⁽⁴⁾

Overall, in 2021, the most commonly reported bacterial species was E. Coli (39.4% of all reported cases), followed by S. Aureus (22.1%), K. Pneumoniae (11.9%), E. Faecalis (8.8%), E. Faecium (6.2%), P. Aeruginosa (6.1%), Acinetobacter spp. (3.0%) and S. pneumoniae (2.5%).⁽⁵⁾

The causes of antibiotic resistance are complex. They include a superfluous use of antibiotics, which increases the selective pressure on bacteria and favors the emergence and multiplication of resistant strains.⁽⁶⁾ Bacterial infections require rapid action, which cannot always wait for an accurate diagnosis and identification of the pathogen.⁽⁷⁾ 

Antibiotic resistance is a challenge that should be faced globally, by implementing programs and policies that improve the level of global health.⁽¹⁾ 

The WHO Global Strategy for Containment of Antimicrobial Resistance (2001) provides a framework of interventions to slow the emergence and reduce the spread of antimicrobial-resistant microorganisms, such as:

• strengthen healthcare systems and their surveillance capabilities;
• ensure access to the right antibiotics, promoting their appropriate use;
• comply with sales and production regulations;
• encourage innovative solutions for using these drugs.⁽⁶⁾

Reinforcing antibiotic resistance surveillance is necessary to gather information on AMR extent and trend in an area ⁽⁶⁾, on antibiotic use by patients and health professionals⁽⁸⁾ and on the effectiveness of implemented interventions.⁽⁹⁾

Changes in the lifestyle of patients with serious infections: relationship problems, mental disorders and day-to-day difficulties

The brain can detect and regulate localized or systemic inflammation through specific brain structures and nerves, which convey the detected inflammatory signal to the central nervous system.

Inflammations are specifically identified by the vagus nerve, while the brain structures perceive and integrate these messages, responding by activating various organic systems such as the hormonal one. In particular, neuronal and endocrine activation is characterized by the release of cortisol, the main stress hormone, and by behavioral changes affecting mood, attention, sleep and appetite.

This response has the purpose of controlling inflammation: a serious infection can indeed trigger this defense mechanism developed by the body to fight inflammatory stress. A severe infection as sepsis can be associated with psychological disorders such as anxiety, depression and post-traumatic stress disorder. These conditions might even increase the risk of suicide and have a lasting personal, social and professional impact on the quality of life of patients with infections.⁽¹⁰⁾ 

Hence, a better understanding and knowledge of the perspective of patients facing these types of infections is essential to improve person-centered healthcare.⁽¹¹⁾  

The impact of isolation on patients with infections

Hospital infections caused by super-resistant bacteria, that is, strains resistant to most antibiotics, are increasingly frequent in hospitals around the world. Various containment strategies are implemented, including the isolation - also preventive - of patients.⁽¹²⁾  The goal is to prevent the transmission of antibiotic-resistant pathogens, those that are highly contagious or can cause serious infections.⁽¹³⁾ 

In general, hospital isolation precautions, especially if preventively implemented, are mostly short-term and are not stressful for the patient. In fact, a study investigating the psychological impact of short-term isolation measures in hospitalized patients, published in the Journal of Hospital Infection in 2010, did not reveal any differences in levels of anxiety and depression between short-term and non-isolated patients. All in all, isolated patients had a positive attitude towards precautions taken for infection prevention.⁽¹²⁾ 

Other studies, however, showed that being in a limited space without any contact with family members generated states of anxiety and concern in patients. Women were more afraid of transmitting the infection to visitors, while men had a more rational approach and tended to better tolerate isolation. On the other hand, the elderly felt sad and lonely.⁽¹⁴⁾ 

It’s not always easy to isolate patients, especially when they don’t understand the actual need for it, and when anxiety and fear generate a less cooperative behavior. ⁽¹³⁾ 

Hence, it is necessary to find alternatives to prevent the negative psychological effects associated with isolation, without compromising the infection prevention strategy. For instance, hospitals should always keep their staff updated and focus on certain aspects such as room layout in wards, patient contact time (both for healthcare staff and visitors) and communicating information more effectively. Additionally, there should be personalized risk assessment for each patient. ⁽¹⁴⁾ 

Involving patients and caregivers to prevent infections

To prevent and reduce hospital infections, human factors and aspects related to the transmission of infectious agents should be considered, especially in the case of super-resistant bacteria. The involvement of patients, family members and caregivers is essential to improve health security.

Hence, in healthcare establishments, patients and visitors need to be well informed about what they can do to avoid infections and prevent them from spreading.

Healthcare professionals should therefore, wherever possible:

• explain infection prevention and control processes to patients and caregivers;
• involve patients and caregivers in the process and delivery of care; 
• ensure that patients and caregivers know they can ask questions to healthcare professionals.

Information materials, such as brochures and posters, can be useful, just like hand hygiene videos, both for patients and visitors.⁽¹⁵⁾ Moreover, it is important that patients report staff failing to follow safe hygiene practices.⁽¹⁶⁾

Regarding personal protective equipment (PPE), information should be provided to patients and family members on their use, combined with a demonstration of how to put it on and take it off. It is also useful to explain the measures adopted in the hospital to prevent the spread of infections, and the risks associated with the inappropriate use of antibiotics, answering questions with clear and direct explanations. ⁽¹⁶⁾

MC-ID-40-2023