In many countries, indiscriminate antibiotic use in humans, agriculture and animals used for food production has led to the rise of bacteria that are resistant to all commercially available antibiotics. Although the problem had been limited to countries outside the U.S., in April 2016 this changed after a 49-year old woman in Pennsylvania developed an infection with a strain of E. coli that was resistant to all antibiotics. The frequency of these types of incidents has many asking, “Have we returned to a pre-antibiotic era?”
The international crisis of antibiotic resistance took center stage in September when the United Nations General Assembly hosted a meeting to discuss the issue. This action by the U.N. is significant. It marks only the fourth time in the organization's history that a health topic is part of their meeting. And for good reason.
The Centers for Disease Control and Prevention estimates that in the U.S. 2 million people become infected annually with bacteria that are resistant to antibiotics. Approximately 23,000 people die each year as a direct result of these infections.
A key method for decreasing antibiotic resistance and securing the effectiveness of current antibiotics is through antibiotic stewardship. This coordinated interdisciplinary program promotes the appropriate use of antibiotics to improve patient outcomes, reduce antibiotic resistance, and decrease the spread of infections caused by multidrug-resistant organisms.
A recent meta-analysis of studies on the efficacy of antibiotic stewardship programs, or ASPs, in hospitals showed an effective program can reduce antibiotic use by 20% overall, and up to 40% in the intensive-care unit. ASPs can also result in substantial cost savings through the reduction of unnecessary antibiotics, diagnostic tests, and by reducing length of stay and readmissions. According to the CDC, inpatient ASPs can save hospitals between $200,000 and $400,000 annually. They also note an ASP at the University of Maryland Medical Center in Baltimore saved $17 million over seven years. After the program was discontinued, antibiotic costs increased by more than $1 million, a 32% increase, in the first year.
Beginning in January 2017, ASPs will no longer be optional for hospitals because the Joint Commission will begin surveying hospitals on their programs under its Medication Management Standard (PDF). Hospitals found not in compliance will receive a requirement for improvement and be expected to come into compliance within 60 days after the survey. Further noncompliance may impact their accreditation status.
In addition, the CMS is proposing that all acute-care and critical-access hospitals have an ASP in place as a condition of participation for Medicare reimbursement.
Together these initiatives are placing growing pressure on hospitals to adopt ASPs that follow common best-practice standards. Amid these developments, as well as the U.N. meeting, what's clear is that the threat antibiotic-resistant organisms pose to public health can no longer be brushed aside and hospitals must take a leadership role in stopping the return to a pre-antibiotic era. Regardless of their size or financial and employee resource limitations, successful ASP programs are within reach for every hospital.
Below are five effective strategies that hospitals can pursue to implement an effective ASP, even in a resource-challenged setting:
Sulfa and penicillin were the medical miracles of the 20th century. They were the leading edge of the antibiotic era that saw dramatic decreases in death rates from infectious disease. With the emergence of antibiotic resistance, we must ask ourselves, are we witnessing the end of an era? Lives are truly at stake and adopting effective ASPs is a solid first step toward securing the future of medicine.
Kristi Kuper, Pharm.D, is a senior clinical manager of infectious diseases for Vizient, formerly known as the VHA-UHC Alliance.