Antibiotic resistance is a threat to national security.
That's how President Barack Obama described the rapid growth of such resistance when he issued an executive order in September instructing HHS and the Defense and Agriculture departments to take aggressive action on the issue.
The president cited federal data showing that at least 2 million Americans are infected with drug-resistant bacteria each year and 23,000 die as a result. He emphasized the critical need for improved antibiotic stewardship—coordinated practices promoting the appropriate use of antibiotics—in healthcare facilities. Federal officials say such programs are among the most effective ways to curb resistance and reduce the number of hard- or impossible-to-treat infections.
A growing number of hospitals are instituting stewardship programs, which experts say not only improve patient outcomes, but also reduce costs and lengths of stay and lower antibiotic-resistance rates within hospitals. Those efforts have been bolstered by looming federal action that would make the inclusion of a stewardship program a requirement to participate in Medicare.
But many hospitals—especially smaller, community facilities—face tough challenges, often related to inadequate staffing and resources. Increasingly, however, those hospitals are using telemedicine, local partnerships and other creative strategies to push stewardship forward.
Intermountain Healthcare is conducting a 15-hospital study on running stewardship programs in smaller hospitals. Kenmore Mercy Hospital, a 155-bed facility in Buffalo, N.Y., is collaborating with independent physicians in its accountable care organization to educate its staff on antibiotic best practices. Other smaller hospitals in California and Minnesota have contracted with infectious-disease, or ID, specialists to lead their programs.
“We can't control how fast bacteria develop resistance or how fast we develop new drugs, but antibiotic stewardship is 100% under our control,” said Dr. Arjun Srinivasan, associate director for healthcare-associated infection prevention programs at the Centers for Disease Control and Prevention. “I would go so far as to say antibiotic stewardship is one of the most important things we can do.”
Stewardship initiatives vary widely. But in a March report, the CDC listed the core elements for such programs, which include a commitment from senior leadership, tracking and reporting of antibiotic prescribing patterns and resistance, clinician education and the appointment of a single person to lead the effort.