Studies show that Half of all antibiotics prescribed in US hospitals are inappropriate, which have contributed to the outbreak Antibiotic resistant microbes. Dr. Arjun Srinivasan is the Associate Director for Health Care Infection Prevention Programs at the National Center for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases. For most of his career, Srinivasan ran a unit that investigated infectious disease outbreaks in hospitals and other health care facilities. Today, he leads the CDC’s effort to improve the use of antibiotics in hospitals.
The CDC estimates that more than 2 million people are infected with antibiotic-resistant organisms each year, resulting in approximately 23,000 deaths annually. In 2014, the CDC recommended that all acute care hospitals implement “antibiotic stewardship programs”. Srinivasan, who will speak in upcoming US news Tomorrow hospital The conference talked with US News about the risks of resistant infections and the role antibiotic stewardship programs play in preventing them. (The interview has been edited for length and clarity.)
What is antibiotic stewardship?
We cannot control how bacteria develop resistance. And, as a physician, I cannot control how fast new antibiotics get on the market. What I can do is improve how I use antibiotics. This is where antibiotic stewardship comes in. These programs can optimize the treatment of infection and reduce adverse events associated with antibiotic use.
We are in a moment of crisis regarding antibiotic resistance. For some patients, we completely rule out antibiotics that work. We have patients in hospitals in the United States who have infections that their doctors cannot treat. This is something that fundamentally threatens our ability to deliver modern medicine. Much of modern medicine has depended on the treatment of infections. for example, [consider] Cancer chemotherapy, when we weaken someone’s immune system with powerful chemotherapy … still continue to do [these treatments], We need to manage infections. Improving the use of antibiotics is one of the most basic things we can do.
Dr. Arjun Srinivasan leads disease control and prevention efforts to improve the use of antibiotics in hospitals.Courtesy CDC
What is required for antibiotic stewardship?
The CDC has developed the seven core elements required for antibiotic stewardship programs. … The elements are: hospital leaders must be committed and ready to supply resources; An effective program leader who is accountable for achieving results; A pharmacist with antibiotic expertise; Recommended actions such as re-evaluating patients’ need for antibiotics after a specified period of initial treatment; Antibiotic prescribing and resistance pattern monitoring; Regular reporting of information on antibiotic use and microbial resistance to doctors, nurses and related staff; And education to give clinicians important information about optimal prescription and antibiotic resistance.
How many hospitals in the US have antibiotic stewardship programs?
Approximately 40 percent of hospitals in the US say they have implemented all seven key elements of the CDC, based on answers to questions we asked in the National Healthcare Safety Network Annual Facility Survey, which includes about 4,000 acute in the US Includes care hospitals that voluntarily present patient-safety data for the CDC.
How difficult is it for hospitals to monitor antibiotic use?
It is evident, [approaches] Those built into the system are so much more than the things that busy providers have to remember every day. We have seen great success in working with hospitals through their pharmacy, laboratory or electronic health records, which put providers into the system to alert them to issues [involving] Antibiotic Prescribing. For example, a provider may receive a warning to indicate that a person is receiving the antibiotic orally with intravenous or other medications. This prompts the provider to see if this person can be a candidate for the switch. … Balance [to strike] To ensure that you have the correct number of alerts; If you have many, people ignore them.
How effective is antibiotic stewardship?
It is effective on various fronts. There is a good study showing that antibiotic stewardship programs tend to have higher infection rates in patients and lower treatment failure rates, indicating that providers do a better job of treating patients. We know that hospitals that have implemented these programs have decreased to clostridium difficile rates – this is one of the huge effects of antibiotic stewardship programs.
These benefits seem so obvious, yet more than 60 percent of hospitals have not adopted antibiotic stewardship programs. Why?
This is the important question. This is what we are trying to understand. For those who have not done all seven core elements, which you have not implemented? Are there any that are particularly challenging? Are there areas where people are really struggling? We are seeing its results [NHSN] Survey to try to find out.
Do you see high adoption rates in some types of hospitals?
Yes we do. We see adoption rates in larger hospitals higher than in smaller hospitals, and we see slightly higher adoption rates in teaching hospitals than non-teaching hospitals, although this likely reflects a size issue. I think the real difference we are seeing right now is that large hospitals are more successful in implementing all these elements than smaller hospitals. We are trying to figure out what that difference is and trying to bridge it. … The key is to work with small hospitals that have done this, learn lessons and hold them as a model for small hospitals that probably haven’t yet.
Are hospital leaders on board?
American Hospital Association [whose members are hospital executives] Has been on board for some time. Last year when the CDC released Key Elements, the AHA released a tool-kit and identified antibiotic stewardship as one of the top five things hospitals can do to use resources efficiently.
What about the patients? What role do they play?
We have gained some experience from our work in infection control that helps us understand what happens behind the scenes in the hospital, with patients actually playing an important role. Historically, all infection control tasks occurring in a hospital were invisible to patients. They didn’t see much [it] Or know how to ask questions about it. he changed; Now people are more busy about asking providers to wash their hands. … We want to see the same culture with antibiotics. We want people to know when they are in the hospital: what antibiotics am I taking? What are they being used for? What infection is being treated? Are bacteria causing infection by that antibiotic? How long do I need that antibiotic? Do I need it intravenously or can I take it orally?
We hope on our report [antibiotic stewardship] To conduct the survey in the coming months. Another huge thing that will develop over the next year revolves around measurement of antibiotic use in hospitals. It has been a big difference for a long time. We do not have a good knowledge about antibiotic use within the walls of hospitals. … what we want to do – and this is what some hospitals have asked us – is [develop] Benchmarking Type [standards] We are capable of infection control. [Hospitals] Want to compare their antibiotic use with hospitals that look like them and see where they fit. Are they really doing well? We have proposed for the first time an antibiotic benchmarking measure on antibiotic use for the National Quality Forum [a group that evaluates new health care performance measures]. This is its first obstacle. We expect the measure to be approved and approved by the NQF in early 2016.