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"Make Antibiotics Great Again:" A Reflection on Antibiotic Stewardship

MAR 30, 2017 | KRISTI ROSA
On March 29, 2017, in the Opening Plenary at the 2017 Society for Healthcare Epidemiology of America (SHEA) Spring 2017 Conference, held in St. Louis, Missouri, Sara Cosgrove, MD, MS, current president of SHEA, associate hospital epidemiologist and professor of medicine at Johns Hopkins School of Medicine, discussed the new landscape of antibiotic stewardship (AS) with a room full of eager attendees. She highlighted where AS was in the past, where it is now, the pros and cons of new requirements, and a program that may achieve sustained improvement in antibiotic use.

Dr. Cosgrove started off the discussion by explaining how the goals for AS programs have changed over time. She said that when AS programs were first put into place, it seemed that the “driving force” behind them was to reduce cost when it came to antibiotics. Back in the 1990s and 2000s, there was only somewhat of a focus on reducing antibiotic resistance, and stewardship was not really thought of as a patient safety issue.

Now, however, the driving force behind these programs appears to have shifted. “I think we have changed a bit, and now there is a recognition that antibiotic stewardship is not just there to save money. I like to really believe that there has been a shift to antibiotic stewardship being there to optimize the safety of patients [receiving antibiotics]," explained Dr. Corsgrove, which means that if they do not need them anymore, healthcare providers stop prescribing them. Having a common vision dedicated to optimizing patient safety is “where we are now.”

Dr. Cosgrove shared that there are national requirements for antibiotic stewardship that are emerging across all healthcare settings. In fact, 48% of hospitals “have robust antibiotic stewardship programs as defined by the Centers for Disease Control and Prevention (CDC).” However, she also noted that when it comes to long-term care or ambulatory practices, there are not many that have organized AS activities, and although a national surveillance system for inpatient antibiotic use is currently in place, there is slow uptake.

When it comes to acute care, there is one requirement that calls for “antibiotic stewardship in hospitals and other settings,” and according to Dr. Cosgrove, and “this is a major driver moving forward.” So, what does the requirement look like? It takes the form of The Joint Commission (TJC)’s “Eight Elements of Performance,” which are as follows:
  1. AS is an organizational priority
  2. Educate staff about AR and AS
  3. Educate patients/families about appropriate antibiotic use
  4. Create an AS multidisciplinary team (ID physician, pharmacist, IP [infection preventionist], practitioner
  5. Ensure Antibiotic Stewardship Programs (ASPs) include the CDC Core Elements
  6. Utlize organization-approved multidisciplinary protocols
  7. Collect/analyze/reports data on ASPs
  8. Take action on improvement opportunities identified by ASPs

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