In March of 2013, the Centers for Disease Control and Prevention (CDC) issued a major report stating “the increase in the number of rare, but potentially deadly superbugs resistant to nearly all last-resort antibiotics has prompted health officials to renew warnings for US hospitals, nursing homes and other healthcare settings.” This was immediately followed by a paper from the UK’s Chief Medical Director declaring antibiotic resistance a “nightmare.” Following up on this release, Reuters News Service related that vancomycin-resistant enterococci (VRE) is only a small part of the story and that the pipeline for new antibiotics to fight resistant organisms is not forthcoming.
Resistance is not the same everywhere. Antimicrobial resistance patterns in hospitals vary and are susceptible to local conditions. The only way for a hospital to know how its program compares with similar facilities is by assessing its current use process, cost and resistance against similar data and practices with other facilities in the region. The resulting analysis will lead to discovering the extent of antimicrobial resistance and some causative factors.
The most effective place for facilities to begin is to have an assessment carried out by an independent team that is uninvolved with the issues and departmental biases that comprise internal institutional politics. From this type of review a new process can be formulated, negotiated and then implemented. Most clinicians are unaware of the issues that are specific to their hospital and how this compares with surrounding similar facilities. They are often surprised to learn that without a strategic vision for current prescribing habits, the future effectiveness of antibiotics for all patients in that hospital and throughout the community will be affected.
Our experience is that antimicrobial stewardship programs that have been well designed and implemented have experienced a range of effectiveness in mitigating further resistance. This is further evidenced in numerous studies showing specific improvement in clinical outcomes as well as financial savings. Consider the following findings in the professional literature referenced below.
– Reductions in antimicrobial use ranging between 11% and 38%.
– Increases in appropriate antibiotic use by between 20% and 24%.
– A reduction in the duration of antibiotic therapy by 18%.
– A reduction in length of stay of 0.5 to 1 day for patients with infection.
– An overall drop in 30-day readmission rate for infection of 0.5 to 0.8%.
– Overall reductions in antimicrobial resistance
– Increased savings of between $200,000 and $900,000 in both larger academic hospitals and smaller, community hospitals.
1. Davey P, Brown E, Fenelon L, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Collaboration.John Wiley & Sons. 2009.
2. Roberts R, et al. Hospital & societal cost of antimicrobial-resistant infections in a Chicago teaching hospital: Implications for antibiotic stewardship. Clin Infec Dis. 2009;49(8):1175-1184.
3. Fishman N. Antimicrobial stewardship program – striking back at antimicrobial resistance. Am J Med.2006;119(6, suppl 1):S53-S61.
4. Dellit TH, Owens RC, McGowan JE Jr, et al. Infectious Diseases Society of America and the Society of Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159-177.
Owens RC, Fraser GL, Stogsdill P; Society of Infectious Diseases Pharamcists. Antimicrobial stewardship programs as a means to optimise antimicrobial use. Pharmacotherapy. 2004;24(7):747-753.