Premier on Tuesday launched a nationwide initiative to combat "superbugs."
The Charlotte, N.C.-based group purchasing company is part of a growing army fighting antibiotic-resistant illness.
In making its announcement, Premier noted that 2 million people in the U.S. are infected each year with antibiotic-resistant bacteria, resulting in some 23,000 deaths and related healthcare costs of up to $20 billion.
Premier and the Centers for Disease Control and Prevention collaborated on research last year that found that unnecessary and duplicative antibiotic use in U.S. hospitals wasted about $163 million between 2008 and 2011. The study described this amount as “almost 2% of the total expenses for all U.S. hospitals for 2012” and noted that the actual amount “could be substantially higher.”
Premier's new initiative was launched in 50 hospitals in 24 states and will track efforts to reduce by 20% inappropriate intravenous use of 23 antibiotic combinations.
Leslie Schultz, director of the Premier Safety Institute, said they will look at patients receiving dual intravenous delivery of antibiotics for three days. She said that usually one antibiotic is sufficient.
“Within 72 hours, your cultures should be back and you should be able to de-escalate,” Schultz said. She added that, within that time period, hospitals should ensure that they're using the right drug for the right type of infection.
In the research Premiere conducted with the CDC last year, three years of pharmacy data from 505 hospitals were analyzed and 32,507 cases of redundant antibiotic treatment were identified. In all, potentially unnecessary antibiotic combinations lasting two or more days were evident at 78% of the hospitals studied.
The intent is to use common, transparent data sets and to share experiences about what practices worked and which did not. There will be monthly webinars and regularly scheduled “coaching hours” where participants can problem solve with Premier faculty.
“Sometimes it's more important to share what did not work,” Schultz said. “My greatest hope is that we make early progress and that the participants communicate loudly, 'This is working and it's a great use of my time.' A lot of people doing the right thing, that would be nice.”
Another goal is to create a business case for antibiotic stewardship, Schultz said.
“These are the early adopters,” Schultz said. “They are going to make the case that there is a return on investment and that this is the right thing to do for patients.”
Schultz said efforts such as Premier's could provide useful evidence for the National Quality Forum, which is evaluating a performance measure for antibiotic use. The NQF is closing the public comment period on that measure on Thursday.
The CDC wants to take data hospitals are already collecting and use it to compare individual hospitals against the national average.
“The antimicrobial use data that are in scope for this measure are antibacterial agents administered to adult and pediatric patients in a specified set of ward and intensive-care unit locations: medical, medical/surgical, and surgical wards and units,” the proposed measure reads. “The measure compares antimicrobial use that the hospitals report with antimicrobial use that is predicted on the basis of nationally aggregated data.”
Dr. Helen Burstin, NQF chief scientific officer, said the NQF supports the White House's National Action Plan for Combating Antibiotic-resistant Bacteria, which is a five-year plan to identify outbreaks and develop new antibiotics. She added that Premier's initiative is a “very natural feed-in” to NQF efforts.
“It's a serious threat, not just in the U.S., but globally as well,” Burstin said. “Part of it is that it's not always clear that all clinicians view it as a problem.”
She said physicians need to be educated that “the way you've always done it,” may not be the way it should be done in terms of antibiotic prescribing. Also, patients who visit a doctor expecting to receive an antibiotic prescription need to know that may not be the best course of treatment.
Burstin said she expects a rapid response as the need to address antibiotic-resistant bacteria has accelerated the hunt for a solution.
“I don't foresee a 10-year horizon,” she said. “I see a two- to five-year horizon because we have to move quickly. The issue is that urgent.”
The American Medical Association declined to directly comment on Premier's initiative but said its Council on Science and Public Health will release a report on antibiotic resistance at its House of Delegates interim meeting Nov. 14-17 in Atlanta. The AMA also plans to hold an education session to update physician leaders on the problem and to promote stewardship.
Burstin noted that it's an issue that extends from the primary-care office to acute hospital settings. The AMA added that it also extends to agriculture where antibiotics are used to promote growth in livestock and it called for an end to that practice.
