The New War on Bugs: Crafting an Effective Antibiotic Stewardship Program | Healthcare of Tomorrow
The White House has put out an aggressive call for action to combat bacteria that become resistant to drugs, which has become a leading infection issue in the country. Along with their initiative has come calls from the Centers for Disease Control and Prevention, infectious disease specialists and industry leaders.
The resistance often develops because antibiotics are prescribed too often or inappropriately in a health care setting; they also are used in foods and in feed given to animals. Repeated exposure to antibiotics can cause bacteria to mutate or take on new genes, making them resistant to medicines, which become unable to kill them or inhibit their growth.
In U.S. hospitals, more than half of all patients are treated with antibiotics, and much of it is done incorrectly. Still, people’s health and lives are often contingent on whether they are given antibiotics when they truly need it.
Health and infectious disease leaders in a panel Tuesday at the U.S. News Hospital of Tomorrow conference in the nation’s capital discussed the problem of antibiotic-resistant bacteria and what hospitals are doing to prescribe antibiotics properly.
The panel, titled “The New War on Bugs: Crafting an Effective Antibiotic Stewardship Program,” included Dr. Marci Drees, hospital epidemiologist and infection prevention officer at Christiana Care Health System; Dr. Brad Spellberg, chief medical Officer for Los Angeles County and the University of Southern California Medical Center; and Dr. Arjun Srinivasan, associate director for health care associated infection prevention programs in the division of health care quality promotion at the CDC.
Anne McGrath, managing editor at U.S. News & World Report, moderated the conversation.
- Spellberg explained that antibiotics were the only types of drugs that suffer from transmittable inefficacy over time. “We are never going to get ahead of resistance,” he warned, saying it was inevitable because of the way the drugs work. “When you take an antibiotic, it affects my grandchildren’s ability to have effective antibiotics. … We’re all in it together.”
- Spellberg said that the mess the country is in when it comes to antibiotics was not stumbled upon, but was a direct result of how providers prescribe antibiotics, and the way they have done so since the 1930s. “We absolutely need to do things very differently than we have in the past,” he said.
- Drees discussed how Christiana Care Health System was managing its antibiotic resistance program, explaining the importance of using metrics to track how a hospital improves over time, and to compare hospitals against each other. “If you can show someone that their antibiotic use, for instance, is 20 percent higher than their peers, then that has a difference,” she said.
- The problem with many providers, Spellberg said, is that they often prescribe antibiotics because they fear what a patient might have or of the unknown, not knowing how much a patient might be harmed by their use down the line. “If you walk down the hall of any hospital, odds are every patient is taking an inappropriate antibiotic,” he said.
- The CDC said hospitals should have an antibiotic stewardship program. Srinivasan specified some of the key elements to a successful program include: leadership commitment from a hospital’s administration, single pharmacy leader, antibiotic use tracking, educating providers and regular reporting on use and resistance. So far, Srinivasan said, nearly 40 percent of hospitals met all elements by 2014. The agency’s goal is to get 95 percent of hospitals on board by 2020.
- Drees said that the types of interventions that hospitals implement should further streamline how the hospital works, not make it more difficult for staff to do their jobs. “Intervention should make less work, not more, for frontline providers,” she said.
Though antibotics are prescribed for well-meaning reasons, the current state of hospitals’ issues with antibiotic-resistant bacteria demonstrate they can have the opposite effect and lead to serious infections. Hospital leaders hope that better tracking data and implementing stewardship programs will drastically reduce the rates of infections within the next few years.