Establishing an anti-microbial stewardship program can be an effective way to reduce dangerous antibiotic resistance and improve patient outcomes, Dr. David Calfee, associate professor of medicine and public health at Weill Cornell Medical College, New York, told attendees in San Antonio at the annual meeting of the Association for Professionals in Infection Control and Epidemiology.
Doc touts anti-microbial stewardship programs
Anti-microbial stewardship programs essentially seek to combat inappropriate use, such as prescribing antibiotics for viral infections, prescribing a more broad-spectrum antibiotic than is necessary or failing to narrow a patient's antibiotic regimen when indicated, Calfee said during a conference session. “It's about optimizing benefit and minimizing risk,” he said.
Calfee cited research that found that at least 30% of anti-microbial use in hospitals is inappropriate. Patients who are infected with multidrug-resistant organisms have higher medical costs, longer lengths of stay and higher rates of mortality, he said. Adding to the worry is the lack of new treatments in the pipeline.
“We aren't developing new drugs in a way that keeps up with the pace of resistance,” he said.
But anti-microbial stewardship teams, charged with identifying problems and interventions, can significantly reduce anti-microbial use, combat resistance and lower healthcare costs, he said.
While such teams at large academic medical centers often consist of an infectious-disease physician and a clinical pharmacist with infectious-disease training, smaller hospitals with less staff and fewer resources can create teams using other professionals, such as infection preventionists, Calfee argued. “There are a lot of opportunities to bring in different people who are not the classical components of an anti-microbial stewardship team,” he said.
In his talk, Calfee also recommended several guidelines for anti-microbial stewardship teams, such as the use of preauthorization for certain medications. Also, he advised performing audits after patients had been on antibiotics for two or three days to assess whether there should be a change in treatment.
“Clinician education is helpful, but it needs to be included with restrictions and audits,” he added.
Send us a letter