When antibiotics are prescribed inappropriately, bacteria become resistant to the drugs, diminishing the ability of providers to effectively treat patients with complex health care needs. Antibiotic stewardship programs can improve patient safety and ensure the continued efficacy of antibiotics.
Jennifer Pisano, MD, associate medical director of The University of Chicago Medicine’s Antimicrobial Stewardship Program, explains the importance and impact of antibiotic stewardship programs at essential hospitals.
What would you say is the No. 1 reason hospitals need to pay more attention to antibiotic resistance?
There are many reports already of bacteria that are unable to be treated with the current antibiotics we have available and too few new antibiotics in development. It is imperative that not only acute care hospitals, but also clinics, nursing homes, long term care facilities and any institution that may prescribe antibiotics be mindful about their use so we can continue to use the antibiotics we have available to treat and cure infections.
Why is antibiotic resistance a major concern? What makes it a difficult problem to tackle?
Antibiotic resistance is a major concern because it contributes to more than two million infections and more than 20,000 deaths each year in the United States, according to the Centers for Disease Control and Prevention.
Preventing antibiotic resistance requires a multidisciplinary approach, stewardship to promote antibiotic mindfulness, and — hopefully — the development of resistance and infection control to prevent the spread of resistant bacteria when they are present. We need to make sure the correct tools are at the fingertips of the prescribers to make informed antibiotic choices from the start and ensure education about stewardship reaches providers at every level.
What are the major components of The University of Chicago Medicine’s antibiotic stewardship program? When was the program launched and how has it changed over time?
Antibiotic restriction has been ongoing at The University of Chicago Medicine since the 1990s. However, our Antibiotic Stewardship Program was formalized in 2010. We are a multidisciplinary team of both adult and pediatric infectious diseases physicians, infectious diseases-trained clinical pharmacists, and infection preventionists and have grown to have team members and collaborators in microbiology and information technology.
In the beginning stages of the program, we focused on decreasing antibiotic utilization and cost and are currently focused on incorporating more safety initiatives into our daily activities, including reviewing real-time alerts when blood cultures are positive and when antibiotic susceptibility results become available to ensure our patients are on the right antibiotic therapy. We are currently working toward expanding initiatives to our outpatient clinics and increasing collaborations with our nursing staff.
What results have you seen with the program?
We have seen decreased utilization of many of our high-impact antimicrobials and an estimated cost savings of approximately $800,000 per year, compared with costs prior to the formalization of our program. The number of interventions that we have made in contacting providers to add or change antibiotics as a result of our blood culture and antibiotic susceptibility reports have increased through the years, hopefully resulting in higher quality of care for our patients. Our recommendations are more than 95% accepted by our providers.
What have you learned about antibiotic stewardship?
I have learned that we all need to be stewards to be successful both inside and outside the hospitals and clinics. As health care workers, it is essential that we partner with our patients to know when antibiotics work, and that we work together to ensure that antibiotics are used only when absolutely indicated.
When inappropriate antibiotics are used, it is most commonly because well-meaning prescribers are not aware of new guidelines or new data to make more informed choices — it does not occur intentionally. As every specialty will use antibiotics in some way, it is difficult to keep up with new information available everyday. It is the stewardship program’s job to filter through the data and the updates and guidelines and ensure usable information is at the fingertips of the providers to make the best choices for their patients.
How do you engage patients in antibiotic resistance awareness?
Over the years, I have found that patients are more and more aware of unintended consequences of antibiotic use, including the disruption of their own good bacteria — the microbiome — especially as probiotics are becoming used more widely. As more and more people are affected or know someone who has had Clostridium difficile (C. diff) diarrhea, which can take hold when our good bacteria are wiped out by antibiotics allowing C. diff to take hold, more patients want to ensure that they are only taking antibiotics when absolutely needed. I love having these conversations!
As a health care system, we need to do better to engage, educate, and empower patients to have these conversations with their providers.