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Antimicrobial Stewardship: Combating Antibiotic Resistance

Last Updated  10/21/2020

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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 Clostridioides 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, the Centers for Disease Control and Prevention (CDC) recommended that all acute care hospitals opens in a new tab implement Antibiotic Stewardship Programs. Since then, CDC has expanded the scope of settings to include: nursing homes/long-term care opens in a new tab and outpatient opens in a new tab sites.

In 2014, CDC published the first document that summarized core elements of successful hospital Antibiotic Stewardship Programs. It was intended to complement existing guidelines from healthcare and professional organizations.

During U.S. Antibiotic Awareness Week (Nov. 18-24, 2019), CDC released updated Core Elements in the acute hospital setting. These revised Elements incorporate new evidence and lessons learned from experience with the Core Elements and are applicable in all hospitals, regardless of size.

In 2015, the White House released a comprehensive plan that identified critical actions for key Federal departments and agencies to take to combat the rise of antibiotic-resistant bacteria The National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination opens in a new tab was a phased roadmap that started with acute care hospitals, then expanded to ambulatory and long-term care settings. The plan was developed by the interagency Task Force for Combating Antibiotic-Resistant Bacteria (CARB) in response to an earlier Executive Order opens in a new tab.

The 2015 National Action Plan was 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. Those goals were:

  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

On Oct. 9, the Office of the Assistant Secretary for Planning and Evaluation released the National Action Plan 2020-2025 opens in a new tab. This Plan is also based on the 2014 National Strategy for CARB; it builds on the first National Action Plan released in 2015 by expanding evidence-based activities that have been shown to reduce antibiotic resistance, such as optimizing the use of antibiotics in human and animal health settings, and retains the same goals. The Plan continues to prioritize infection prevention and control to slow the spread of resistant infections and reduce the need for antibiotic use.

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
  • Clinical collaboratives to network and implement data driven clinical improvements and cost reductions, share evidence based practices and learn from top performers