Prevent the Bug, Save the Drug:
The IP as Antibiotic Steward
A Win-Win-Win: Saving Antibiotics Good for Everyone
Some-take home points from the antibiotic stewardship program at Ascension Healthcare in St. Louis include the following, according to Mohamad Fakih, MD, MPH, senior medical director for antimicrobial stewardship and infection prevention at Ascension.
Antibiotic stewardship and infection control efforts include a reminder that all facets of society have a stake in preserving antimicrobial efficacy.
- Resistant organisms can be spread between hospitals and communities and are a threat to all patients.
- A national action plan has been established for combating antibiotic-resistant bacteria.
- A national goal has been set that hospitals have antimicrobial stewardship programs and achieve a reduction in inpatient inappropriate antibiotic use by 20%, by 2020.
- A common and preventable harm [resistance, Clostridium difficile infection (CDI), side effects, and interactions].
- Not all antimicrobials are equal: Optimizing the antibiotics will lead to better outcomes.
The hospital/ healthcare system (in addition to the patient’s perspective):
- Preventing resistance and CDI reduces risk to other patients.
- Treating multidrug-resistant organisms and CDI is very difficult and costly.
- CDI is publicly reported and underperformance is associated with financial penalties.
The following are some specific strategies and goals to rein in antibiotic resistance and improve stewardship used by the Ascension program:
Optimize and standardize antimicrobial therapy.
- Establish minimum appropriate indications, restrictions for acute care hospitals developing clinical pathways, protocols to treat different infections.
- Standardize perioperative antimicrobial prophylaxis.
- Optimize testing for infection workup, which includes identifying and addressing variation; incorporating proper testing in order sets based on evidence; and avoiding testing without clinical indications.
- Use data mining and electronic decision support to enhance appropriate antimicrobial use, including electronic health records to incorporate the indications and duration of antibiotics; and medication management software to support prospective monitoring to improve treatments real-time.
- Evaluate the use of the different antimicrobial classes through a dashboard and directly engage opportunity hospitals to help them improve.
Once largely consigned to separate silos, infection prevention and antibiotic stewardship are starting to show signs of a powerful partnership. The CDC’s most recent update on the threat of antibiotic-resistant bacteria emphasizes that drug stewardship and infection control must essentially be inseparable if they are going to be successful.
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