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    BLOG: Time to show and tell about antibiotic stewardship programs

    Dr GoldsteinGoldsteinPresident Obama’s recent proposal to nearly double funding for antibiotic resistance programs to $1.2 billion in the 2016 federal budget confirms that the battle against “superbugs” is indeed moving up the government agenda. Clearly, there is greater awareness of the serious implications of antibiotic resistance for public health.

    Heading for the postantibiotic era

    Antibiotic resistance is now seen in all parts of the world and threatens the effective prevention and treatment of an ever-increasing range of common infectious diseases as well as the more complicated infections. The development of some resistance should be no surprise, of course, as it occurs naturally as microorganisms replicate and, through horizontal gene transfer, is able to mobilize any resistance gene. The ongoing use and misuse of antibiotics, however, accelerates the emergence of drug-resistant strains. Add this phenomenon to poor infection control and suboptimal sanitary conditions, and you have a potent recipe for the development of multidrug-resistant bacteria—the so-called superbugs.

    Related: Optimize antibiotic stewardship

    According to the World Health Organization, it’s no longer alarmist to warn that without urgent, coordinated action, the world is heading toward a postantibiotic era in which common infections and minor injuries, treatable for decades, can once again kill.1 In the United States alone, the Centers for Disease Control and Prevention (CDC) estimates that each year at least 2 million individuals acquire serious infections with bacteria that are now resistant to 1 or more antibiotics designed specifically to treat those infections. Annually, at least 23,000 die as a direct result of resistant bacteria, but many more die from other conditions that arise from an antibiotic-resistant infection.2

    Antibiotic resistance imposes considerable costs on the already overburdened healthcare system. Estimates vary, but in 2008 dollars, excess direct healthcare costs may be as high as $20 billion, with up to $35 billion in additional costs for lost productivity due to hospitalizations and sick days.2

    Antibiotic stewardship in the battle against resistance

    Published in September 2014, the report by the President’s Council of Advisors on Science and Technology (PCAST) sets out practical steps that the US government should take to bring the antibiotic-resistance crisis under control. The report includes recommendations for stronger federal coordination and oversight, effective surveillance, and basic and clinical research. PCAST also advocates that, by the end of 2017, federal regulations should require US hospitals, critical access hospitals, and long-term care and nursing home facilities to develop and implement robust antibiotic stewardship programs (ASPs) consistent with best clinical practices.3

    Related: AARS, CDC partner on antibiotic awareness

    Antibiotics are prescribed for the majority of patients hospitalized in US acute care hospitals, presumptively to treat infections. Alarmingly, 30% to 50% of these prescriptions may be inappropriate mainly because they are unnecessary or have incorrect antibiotic dosing or duration of therapy.4 By reducing unnecessary and inappropriate antibiotic use and promoting optimal therapy, ASPs are a key weapon against the growing threat of antibiotic resistance and have been clearly shown to improve clinical outcomes, including reductions in mortality.5

    The National Foundation for Infectious Diseases offers a wealth of information and guidance for formulary managers responsible for delivering ASPs in their facilities.6 However, it’s also valuable to “show and tell,” in other words, to share practical lessons with colleagues about their frontline experiences of ASPs. Where better to do this than at Infectious Diseases Week (IDWeek).

    Each year, IDWeek brings together the expertise of members of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. Antibiotic resistance and ASPs were key topics at IDWeek 2014 in Philadelphia, with more than 300 reports of clinical experience not only from the United States but also from the rest of the world. There were, however, some overarching predominant themes.

    De-escalation

    When used as part of an ASP, de-escalation of antibiotic therapy can reduce inappropriate antibiotic use, cost, and adverse events. Other possible benefits of shortened antimicrobial treatment include a lower risk for superinfections, antimicrobial-related organ toxicity, and improved regimen compliance. De-escalation is often implemented with clinical-decision-support system (CDSS) software, but resource limitations may mean that some community hospitals must implement ASPs without this type of support.

     

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