Antimicrobial stewardship encourages using antibiotics only when necessary.
The presence of antibiotic-resistant bacteria has increased over the past few decades, and the development of new antibiotics has decreased. It's a trend raising fears among physicians that, without quick and deliberate action, antibiotics could become useless.
The Center for Disease Control estimated in 2013 that about 23,000 people die a year from antibiotic-resistant infections. Overuse of antibiotics contributes to increases in resistance, which makes infections more complicated to treat.
This month, the Obama administration convened a forum to gather representatives from hospital groups, pharmaceutical companies, and other stakeholders to discuss both the problem and strategies to promote the responsible use of antibiotics.
“I don’t mind having difficult stuff. It makes things interesting,” said Dr. Nicholas Bennett, co-director of the Antimicrobial Stewardship Program at Connecticut Children's Medical Center in Hartford. “But resistant infections delay treatment... They cause excess hospital costs, hospital stays; and they kill people.”
Bridgeport’s St. Vincent’s Medical Center is part of the Ascension Health system, which made made a series of commitments at the White House forum to adopt more rigorous standards for antibiotic use.
Lawrence Scheck, Chief Medical Officer at St. Vincent's, said that there were already antimicrobial stewardship efforts in place at the hospital, but that they will be expanding on their program. The hospital will establish a team comprised of both an Infectious Disease Specialist and an Infection Control Manager to oversee antibiotic use, as well as begin use of the electronic monitoring system Senri7.
Antimicrobial stewardship has been on the radar of the medical community for years, but recent efforts have drawn more attention to the need for such programs. Stewardship programs focus on using antibiotics only when necessary, ensuring that the proper antibiotics are used in treatment of infections, and providing more oversight of infectious diseases.
Fifty percent of people prescribed antibiotics in hospitals are given them incorrectly, according to Dr. Ulysses Wu.
Dr. Richard Melchreit is the program director in the Healthcare Associated Infections (HAI) Program at the Connecticut Department of Public Health.
Established in 2008, the HAI program is involved in surveillance and tracking of infections in the state, and has been assisting health care facilities in their efforts to establish antimicrobial stewardship programs.
“Now that the White House, the national government, the CDC are continuing to develop more guidance on what to do, we’re going to try and work with them to continue to develop those programs in the state,” said Melchreit.
According to Melchreit, the state of Connecticut isn't currently a leader in antimicrobial stewardship and infection management, but its programs are “in the pack.”
“I think there are programs around the country -- excellent ones in Illinois, Washington, Tennessee -- that are the true leaders in this area, but we’re going to work closely with them to build our program and keep up with a really good movement across the country,” Melchreit said.
In 2007, the Infections Disease Society of America and the Society for Healthcare Epidemiology of America publishedguidelines for the establishment of antimicrobial stewardship programs in hospitals. Since then, the organizations have published multiple updatesto their initial statements.
Bennett said there's been significant progress in the field.
“When I first started going to the stewardship [conferences], a lot of emphasis was on how you start stewardship programs, how do you convince your administration to fund you, and why do you need to do it,” said Bennett. “And now, the meetings are now about this is what we’ve done, and this is what we’ve achieved. I definitely think there was a push in the last few years.”
According to Dr. Ulysses Wu, chief of infectious diseases at St. Francis Hospital and Medical Center, the goals of antibiotic stewardship are to reduce the development of resistant bacteria, prevent adverse effects that might accompany antibiotics (such asClostridium difficile infections), and -- lastly -- to reduce costs associated with use of the drugs.
Infectious disease specialists are working to meet those goals through physician education and careful oversight of the prescription of antibiotics. Focus is on both in hospital and outpatient antibiotic use.
“Sixty percent of individuals who get admitted to a hospital will receive at least one dose of antibiotics, and 50 percent of those antibiotics are prescribed incorrectly,” said Wu. “It’s not necessarily the wrong antibiotic...but it’s the wrong dose or the wrong delivery method or whatever it might be.”
Excessive outpatient antibiotic use is also a concern, particularly in pediatrics. Bennett said the majority of pediatric doctor visits end in the prescription of an antibiotic -- even though illnesses can often be viral, and therefore cannot actually be treated with antibiotics. He encourages a “wait and see approach.”
“You can recommend a prescription, but wait and see how they do tomorrow, and you can fill it if you think they need it,” Bennett said. “That does result in a reduction, and the kids do just as well.”
Nicole Wetsman is an intern at WNPR.
