Other Infections

ICAAC 2014: Antibiotic Stewardship Programs Reduce Use and Improve Outcomes

Programs to promote appropriate use of antibiotics in hospitals and other healthcare facilities can help reduce use of these drugs and thereby ameliorate the risk of developing resistance, researchers reported at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy last week in Washington, DC.

Resistance to antibiotic drugs is a growing threat both in the U.S. and worldwide, as described in a report issued last year by the Centers for Disease Control and Prevention. Overuse of antibiotics when they are not necessary, and inappropriate use such as not completing a full course of treatment, can encourage development of resistance.

Nishant Prasad and colleagues from New York Hospital Queens performed a retrospective review of stewardship interventions at their 500+ bed community hospital. They saw reductions in rates of multidrug-resistant Klebsiella pneumonia, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus or MRSA, and Clostridium difficile-associated diarrhea. Plus, appropriate antibiotic use saved more than $600,000 per year.

A similar study by Fredrik Resman from Lund University in Sweden and colleagues found that stewardship efforts involving twice-weekly antibiotic "audits" reduced the use of these drugs by 27% in a geriatric patient population with no notable negative effects.

Below is an edited excerpt from a press release issued by the American Society for Microbiology, which puts on ICAAC, describing the research in more detail.

Antibiotic Stewardship Programs Reduce Costs, Improve Outcomes

Washington, DC -- September 6, 2014 -- Antibiotic stewardship programs, which promote the appropriate use of antibiotics in hospitals and other healthcare centers, not only lead to reduction in antibiotic use with reduced adverse events, but also lead to significant savings. In the case of one New York hospital, more than $600,000 was saved annually, according to research presented today at the 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), an infectious diseases meeting of the American Society for Microbiology (ASM).

"This work emphasizes the rational approach to treating patients: choosing antibiotics at correct doses only when really needed, limiting side-effects, limiting the selection of super bugs, and limiting the risk of infection to new patients admitted to hospitals," says Nishant Prasad, MD, attending physician, The Dr. James J. Rahal, Jr. Division of Infectious Diseases, New York Hospital Queens.  

Dr. Prasad and his colleagues tracked the rate of antibiotic-resistant infections, antibiotic use patterns, and antibiotic-related costs after the implementation of a hospital-wide antibiotic stewardship program at New York Hospital Queens, a 535-bed community hospital in Flushing, New York. At least half of the more than 5,000 interventions made by the program in 2013 improved patient safety and led to more than $600,000 in antibiotic-related savings. Additionally, they found the rate of antibiotic-resistant infections decreased including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and hospital-acquired Clostridium difficile- associated diarrhea.

"With our antibiotic stewardship program, we demonstrated decreased antibiotic use and increased antibiotic-related cost savings, as well as a significant decrease in antibiotic-resistant infections. We believe these findings show that limiting unnecessary antibiotics improves patient safety and streamlines use of limited healthcare dollars," says Dr. Prasad.

Other research presented at the meeting also shows the results of antibiotic stewardship programs. A study carried out by researchers at Skåne University Hospital in Malmö, Sweden during a six-month period at four geriatric wards found a 27% decrease in antibiotic use when guided by a brief discussion with an infectious disease specialist. The reduction did not affect mortality, but a reduction in hospital readmissions due to infection was observed.

"The strategy seems to be a cost-effective, promising way to reduce antibiotic use with very little risk to the individual patient," says Fredrik Resman, Skåne University Hospital, who presented the data. "The success of this very simple strategy has led to a continuation on a permanent basis."

Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable and making other medical advances, like cancer chemotherapy and organ transplants, possible. The prompt initiation of antibiotics to treat infections has been proven to reduce morbidity and save lives. The U.S. Centers for Disease Control and Prevention (CDC) estimates that 20%-50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. A growing body of evidence suggests that antibiotic stewardship programs can both optimize treatment of infections and reduce the incidence of adverse events associated with antibiotic use. 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.

9/16/14

References

N Prasad, N Warren, A Kula, et al. Impact of Antibiotic Stewardship Program Interventions on Multi-drug Resistant Organism Resistance Rates and Hospital Costs. 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2014). Washington, DC, September 5-9, 2014. Abstract K-343.

H Nilholm, L Holmstrand, J Ahl, et al. An Audit-based Antimicrobial Stewardship Significantly Reduced The Use Of Antibiotics In Geriatric Patients With No Negative Effect On Outcome. 54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2014). Washington, DC, September 5-9, 2014. Abstract L-408.

Other Source

American Society for Microbiology. Antibiotic Stewardship Programs Reduce Costs, Improve Outcomes. Press release. September 6, 2014.