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“Handshake Stewardship” Program Sees Drop in Antibiotic Use and C. diff Rates

OCT 30, 2016 | EINAV KEET
Researchers from the Children’s Hospital Colorado and the University of Colorado School of Medicine have taken a unique approach to antibiotic stewardship, cutting back on unnecessary antibiotic prescriptions and devising a strategy to help fight antimicrobial resistance.

About one-third of all antibiotics prescribed in the United States are unneeded, according to a study by the Centers for Disease Control and Prevention (CDC) and the Pew Charitable Trusts published in the Journal of the American Medical Association. This excess of 47 million antibiotic prescriptions contributes to the persisting issue of healthcare-acquired infections from drug-resistant superbugs such as Clostridium difficile. In 2011 about 722,000 people in the United states were infected with healthcare-acquired infections in acute care hospitals, and 75,000 of those patients died during their hospitalizations. Strains of antibiotic-resistant bacteria infect nearly 2 million people in the United States each year, and as a result nearly 23,000 die. The issues of healthcare infections and antibiotic resistance go hand in hand, and in response hospitals around the country are looking to improve the way they prescribe antibiotics by implementing antibiotic stewardship programs.

At the Children’s Hospital Colorado, doctors created a three-point antibiotic stewardship strategy they’ve dubbed “handshake stewardship.” In a study published in The Pediatric Infectious Disease Journal, the doctors detail the methods they used at the pediatric hospital between October 2010 and September 2014. The three features of their approach first included setting no restrictions or preauthorization for antimicrobial prescriptions. Second, all antimicrobials given to the patients were first reviewed by a team of two “stewards:” an antibiotic stewardship program physician and a pharmacist who reviewed customized patient reports. In the third step, the stewards together communicated their recommendations in-person to the team of healthcare providers during clinical rounds. The term “handshake stewardship” conveys what the authors noted was a “sealing of deals” between the stewards and their team.

During the course of the study, overall use of antimicrobials in the hospital dropped by 10.3%, with the pediatric intensive care unit reducing their use of the drugs by 14.5%. Use of vancomycin decreased by 25.7% and use of meropenem decreased by 22.2%. The researchers saw a significant decrease in the rate of hospital-onset C. difficile, which dropped by about 41%.

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