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Antimicrobial Stewardship

 

Antibiotics, medicines used to treat bacterial infections only, are an incredibly powerful tool. The development of penicillin, the first widely available antibiotic, revolutionized our ability to treat many infections. The development of subsequent medicines have allowed effective treatment of not only further bacterial infections, but fungal infections, as well as most parasitic infections and some viral infections. The term "antimicrobial", a broader term than "antibiotic", encompasses medications with activity against multiple infectious agents including bacteria, parasites, fungi, and viruses. These drugs have made once lethal infections readily treatable as well as making other medical advancements feasible such as chemotherapy for cancer and organ transplantation both of which lower our bodies natural ability to defend against infections. The prompt administration of appropriate antimicrobials has been proven to reduce morbidity and save lives1. Unfortunately, these treatments do come with a price: the risk of adverse drug reactions (e.g. allergies and side effects), increasing the risk of Clostridium difficile infection (CDI), and the development of resistant bacteria.

We are now seeing the rise of bacteria resistant to multiple antibiotics, often referred to as Multiple Drug Resistant Organisms or MDROs. One cause of the rapid rise of resistant bacteria is over use of antibiotics. In the U.S. 20-50% of all antibiotics prescribed in acute care hospitals are unnecessary or inappropriate2-7, and at least 30% of outpatient antibiotic prescriptions are unnecessary8. The more bacteria are exposed to antibiotics the more likely they are to develop resistance. This point is nicely illustrated by a video created by Harvard’s medical school.

The NC Division of Public Health’s Surveillance for Healthcare Associated and Resistant Pathogens Patient Safety (SHARPPS) Program is dedicated to the prevention and containment of antibiotic resistant infections. One way we can work toward this goal is through promotion of antimicrobial stewardship across the continuum of care in NC. Antimicrobial Stewardship refers to programs in any healthcare setting that coordinate interventions within that setting designed to improve AND measure the appropriate use of antimicrobials. This means ensuring that the correct drug, dose, duration of therapy and route of administration are used for every patient. The SHARPPS program has developed a recognition incentive and mentorship program to further our mission The STewardship of Antimicrobial Resources (STAR) Partners program. In addition, we participate in CDC’s Be Antibiotics Aware Campaign, and provide education to the public and providers regarding antimicrobial resistance and stewardship. Please see the links below for further information on Antimicrobial Stewardship:

Current NC Stewardship Programs and Activities:

STAR Partners: North Carolina Division of Public Health’s Antimicrobial Stewardship statewide initiative.

Be Antibiotics Aware: Smart Use, Best Care: North Carolina Division of Public Health’s Be Antibiotics Aware Campaign

Be Antibiotics Aware: Smart Use, Best Care (CDC): The North Carolina Division of Public Health is an active partner in the Be Antibiotics Aware: Smart Use, Best Care Campaign, a national public health campaign, and encourages appropriate antibiotic use and the prevention of antibiotic resistance.

Additional Information and Resources:

CDC: Core elements of Stewardship – Acute Care Hospitals
- National Quality Partners Playbook: Antibiotic Stewardship in Acute Care
CDC: Core elements of Stewardship – Long Term Care
CDC: Core elements of Stewardship – Small and Critical Access Hospitals
CDC: Core elements of Stewardship – Outpatient Care
CDC: Training on Antibiotic Stewardship
IDSA: Stewardship program implementation guidelines
SHEA: Antimicrobial stewardship resources

References:

1. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive care medicine. Feb 2013;39(2):165-228.

2. Camins BC, King MD, Wells JB, et al. Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: a randomized controlled trial. Infection control and hospital epidemiology :the official journal of the Society of Hospital Epidemiologists of America. Oct 2009;30(10):931-938.

3. Ingram PR, Seet JM, Budgeon CA, Murray R. Point-prevalence study of inappropriate antibiotic use at a tertiary Australian hospital. Internal medicine journal. Jun 2012;42(6):719-721.

4. Levin PD, Idrees S, Sprung CL, et al. Antimicrobial use in the ICU: indications and accuracy–an observational trial. Journal of hospital medicine : an official publication of the Society of Hospital Medicine. Nov-Dec 2012;7(9):672-678.

5. Patel SJ, Oshodi A, Prasad P, et al. Antibiotic use in neonatal intensive care units and adherence with Centers for Disease Control and Prevention 12 Step Campaign to Prevent Antimicrobial Resistance. The Pediatric infectious disease journal. Dec 2009;28(12):1047-1051.

6. Dellit TH, Owens RC, McGowan JE, Jr., et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Jan 15 2007;44(2):159-177.

7. Fridkin SK, Baggs J, Fagan R, et al. Vital Signs: Improving Antibiotic Use Among Hospitalized Patients. MMWR. Morbidity and mortality weekly report.2014;63.

8. Fleming-Dutra, K., et al. (2016). "Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011." JAMA: the Journal of the American Medical Association 315(17): 1864-1873.