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In a move that underscores the emerging partnership between two leading federal agencies, the Centers for Disease Control and Prevention is crafting antibiotic stewardship guidelines with an eye toward future enforcement by the Centers for Medicare and Medicaid Services. The groundwork for such a plan was discussed Nov. 6 in Atlanta at a meeting of the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC).
With the rise of antibiotic-resistant bacteria, stewardship programs to carefully monitor drug use have risen as a high public health priority. The overuse and misuse of antibiotics in hospitals -- and really across the health care spectrum -- creates selective pressure for more resistant bacterial strains to emerge. With few new antibiotics forecast for the foreseeable future, it has become paramount to preserve the dwindling efficacy of those that remain.
However, CDC officials at the HICPAC meeting said their various guidelines and statements touch on the issue, but fall short of a definitive document on creating an antibiotic stewardship program. Though HICPAC is not expected to formally sign off on the guidelines and open its typically extensive review process, the CDC sought committee input on the idea of creating a how-to guideline that would serve the dual purpose of emphasizing the importance of antibiotic stewardship across the health care continuum.
There was immediate consensus that mere recommendations to adopt stewardship programs would have little effect, with HICPAC members advising the CDC that if this is really a national priority the guidelines should have some “teeth.” It then became clear that the CDC is already in discussion on the issue with CMS, which is increasingly seen as a way to codify traditional voluntary guidelines with pay for performance incentives.
With regard to stewardship, a recent CDC report on the challenge of drug-resistant pathogens concluded that “perhaps the single most important action needed to greatly slow down the development and spread of antibiotic-resistant infections is to change the way antibiotics are used. Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate.”
Two major infectious disease groups -- the IDSA and SHEA -- have previously called for a CMS regulation aligning appropriate antibiotic use with financial incentives. Along with the Pediatric Infectious Disease Society, they issued a position paper calling for the CMS to require the creation of a multidisciplinary antimicrobial stewardship teams in hospitals and other health care settings.1 (See Hospital Infection Control & Prevention, May 2012, p. 49.)
A similar stance by the CDC could go a long way toward making antibiotic stewardship programs a CMS requirement in health care settings.
For more on this important story see the December 2013 issue of HIC.