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Monitoring antimicrobial use, cost, and resistance

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Scope of the problem

Up to 50 percent of antimicrobial use in hospitals is unnecessary and inappropriate. This is not a new fact. The consequences of inappropriate use includes risk of toxicity, increased length of stay, as well as increased costs to patients, hospitals and payors. Antibiotic overuse also contributes to the growing problems of Clostridium difficile infection (CDI). We also know that prolonged and wide use of antimicrobial drugs has contributed to the worldwide problem of antimicrobial drug resistance. There are an increasing number of pathogens that cause serious infections that are resistant to one or more antimicrobial agents, including Methicillin- resistant Staphylococcus aureus (MRSA) and most recently, the emergence of Carbapenem-resistant Enterobacteriaceae (CRE) including Klebsiella pneumoniae carbapenemase (KPC).

A growing body of evidence demonstrates that programs dedicated to improving antibiotic use, commonly referred to as “Antibiotic Stewardship Programs (ASPs)”, can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. These programs help clinicians improve the quality of patient care and improve patient safety through increased infection cure rates, reduced treatment failures, and increased frequency of correct prescribing for therapy and prophylaxis.  They also significantly reduce hospital rates of CDI and antibiotic resistance, while saving hospitals money. In recognition of the urgent need to improve antibiotic use in hospitals and the benefits of antibiotic stewardship programs, in 2014 CDC recommended that all acute care hospitals implement Antibiotic Stewardship Programs.

CDC Core Elements of Successful Antibiotic Stewardship program

The CDC published a document that summarizes core elements of successful hospital Antibiotic Stewardship Programs.  It is intended to complement existing guidelines from healthcare and professional organizations.  There is no single template for a program to optimize antibiotic prescribing in hospitals.  The complexity of medical decision making surrounding antibiotic use and the variability in the size and types of care among U.S. hospitals require flexibility in implementation.  However, experience demonstrates that antibiotic stewardship programs can be implemented effectively in a wide variety of hospitals and that success is dependent on defined leadership and a coordinated multidisciplinary approach.

White House – National Action Plan for Combating Antibiotic-Resistant Bacteria

On March 27, 2015, the White House released a comprehensive plan that identifies critical actions to be taken by key Federal departments and agencies to combat the rise of antibiotic-resistant bacteria.  The National Action Plan for Combating Antibiotic-Resistant Bacteria, which was developed by the interagency Task Force for Combating Antibiotic-Resistant Bacteria in response to the September 18, 2014 Executive Order 13676: Combating Antibiotic-Resistant Bacteria, outlines steps for implementing the National Strategy on Combating Antibiotic-Resistant Bacteria and addressing the policy recommendations of the President’s Council of Advisors on Science and Technology (PCAST) report on Combating Antibiotic Resistance.

The National Action Plan provides a roadmap to guide the Nation in rising to the challenge of antibiotic resistance and potentially saving thousands of lives.  The Action Plan outlines Federal activities over the next five years to enhance domestic and international capacity to prevent and contain outbreaks of antibiotic-resistant infections; maintain the efficacy of current and new antibiotics; and develop and deploy next-generation diagnostics, antibiotics, vaccines, and other therapeutics.  These activities are consistent with investments in the President’s FY 2016 Budget, which nearly doubles the amount of Federal funding for combating and preventing antibiotic resistance to more than $1.2 billion.

Implementation of the Action Plan will require the sustained, coordinated, and complementary efforts of individuals and groups around the world, including public and private sector partners, healthcare providers, healthcare leaders, veterinarians, agriculture industry leaders, manufacturers, policymakers, and patients.

The National Action Plan is organized around five goals for collaborative action by the U.S. Government, in partnership with foreign governments, individuals, and organizations aiming to strengthen healthcare, public health, veterinary medicine, agriculture, food safety, and research and manufacturing.

The Action Plan’s five goals:

  1. Slow the Emergence of Resistant Bacteria and Prevent the Spread of Resistant Infections.
  2. Strengthen National One-Health Surveillance Efforts to Combat Resistance,
  3. Advance Development and Use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant Bacteria.
  4. Accelerate Basic and Applied Research and Development for New Antibiotics, Other Therapeutics, and Vaccines.
  5. Improve International Collaboration and Capacities for Antibiotic Resistance Prevention, Surveillance, Control, and Antibiotic Research and Development.

psi-logo-grey-smallPremier commitment to support the National Action Plan

Premier and its alliance members recognize the critical need for antibiotic stewardship and are committed to reducing antibiotic resistance.   Premier, along with a number of its members joined 150 major stakeholders in the June 2, 2015 White House Forum on Antibiotic Stewardship to share commitments to implement initiatives over the next five years to slow the emergence of resistant bacteria and prevent the spread of resistant infections, to include improvement in antibiotic use and prescribing.  Premier will be focusing its efforts on the first two goals of the White House Action Plan: (1) To slow emergence of resistant bacteria and prevent the spread of resistant infections and (2) Strengthen national surveillance efforts to combat resistance.

psi-logo-grey-smallPremier offers solutions to support antimicrobial stewardship

Premier offers an array of data, technology and performance improvement tools, programs, and initiatives, to achieve the National Action Plan goals and help healthcare providers and organizations implement antimicrobial stewardship programs that strengthen surveillance, reduce inappropriate use and prevent the spread of resistant infections. These resources include:

  • Surveillance and reporting of infections, antimicrobial use, resistance, and related cost;
  • Tracking and monitoring hospital quality, safety, utilization and cost data to target specific issues, including antimicrobial use, pinpoint opportunities for improvement and assess progress; and
  • Clinical collaboratives to network and implement data driven clinical improvements and cost reductions, share evidence based practices and learn from top performers.

Learn more about how Premier can help enhance your antimicrobial stewardship efforts.