Antibiotic Stewardship: A Little Goes A Long Way
Decreases infections, lowers colonization pressure
With antibiotic stewardship programs now critical to preserve fading drug efficacy, it’s good to know that even small efforts can yield considerable bang for the buck.
Antibiotic use and overuse kill off susceptible bacteria, select out resistant organisms, and diminish drug efficacy through this constant selective pressure. Thus, limiting antibiotic use to the degree medically possible should diminish levels of multidrug-resistant organisms (MDROs).
Researchers using a modeling study1 for ICU patients showed reducing antibiotic usage absolutely by 10% — from 75% to 65% — reduced rates of MDROs by 11.2%. A 25% reduction of antibiotics — from 75% to 50% — reduced acquisition rates of high-prevalence MDROs by 28.3%.
“In a critical care setting, where up to 50% of antibiotic courses may be inappropriate, even a moderate reduction in antibiotic usage can reduce MDRO transmission,” the researchers noted.
The mathematical model addressed the aforementioned “microbiome effect” of selective pressure, and also allotted a proportion of patients who develop an MDRO via genetic mutation.
The authors cited previous studies indicating that overall antibiotic use could be feasibly and safely cut back by about one-third.
“Furthermore, overall reduction of antibiotic usage lowers colonization pressure for the entire unit, including for patients who are not receiving antibiotics,” they concluded. “In this scenario, fewer patients receive antibiotics and are therefore less likely to transmit (if they are colonized) or acquire a MDRO (either via a contaminated HCW or genetic mutation). As a result, other susceptible patients in the unit are at a decreased risk of acquisition because HCWs are not exposed as often to colonized patients.”
REFERENCE
- Barnes S, Rock C, Harris A. The Impact of Reducing Antibiotics on the Transmission of Multidrug-Resistant Organisms. Infect Control Hosp Epi March 8, 2017:
https://doi.org/10.1017/ice.2017.34
With antibiotic stewardship programs now critical to preserve fading drug efficacy, it’s good to know that even small efforts can yield considerable bang for the buck.
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