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Regional Approaches to Lessening Antibiotic Resistance

A symposium at the annual meeting of the Infectious Diseases Society of America in New Orleans, Louisiana, highlighted initiatives designed to curb the spread of antibiotic resistance.
The common theme of the symposium was the value of coordinated efforts involving multiple sites in the particular jurisdiction, instead of the silo approach that has long been canon. It has been recognized that no matter how scrupulous antibiotic control is in any one institution, patients coming from environments where precautions are less stringent will undermine the control efforts.
“Antimicrobial stewardship is a quality improvement initiative that has been proven in multiple, peer-reviewed studies to improve patient outcomes, shorten length of hospital stay, reduce Clostridium difficile infection rates, save money, and reduce antimicrobial resistance. Yet, antimicrobial stewardship and infection control interventions have focused on individual institutions without coordination,” said Keith Hamilton, MD, director of Antimicrobial Stewardship at the Hospital of the University of Pennsylvania, in his talk.
California, which has enacted some of the most stringent regulations requiring antimicrobial stewardship, has provided an example of what can be achieved with a more widely coordinated approach.
“Transformative changes in infection control occurred when all healthcare facilities were required to implement infection control programs and required to report healthcare-associated infection rates. This has reinforced that antibiotics are a shared community resource and that antimicrobial stewardship should be seen as a community effort, said Dr. Hamilton.
The approach taken in Pennsylvania and elsewhere recognizes that patterns of bacterial resistance vary by region and that patient transfer between healthcare facilities causes horizontal spread of antimicrobial resistance. “In many cases, resources are not allocated to the facilities in which they may have the most significant impact on the community,” said Dr. Hamilton in his talk.
The Philadelphia Community Antimicrobial Stewardship Collaborative is comprised of 40 area healthcare facilities. The aim is to propagate knowledge and expertise, and foster the establishment of regional research networks. Surveys have indicated a thirst for knowledge of tangible aspects of antimicrobial stewardship.
“Most literature on antimicrobial stewardship has been performed in university/academic hospitals without clearly defined practical advice to ‘real-world’ solutions. Regional collaborations can identify and highlight tools that are effective at changing local prescribing culture,” said Dr. Hamilton in his talk.
Marion A. Kainer, MD, MPH, FRACP, FSHEA Tennessee Department of Health, Nashville, Tennessee, described regional collaboration between health departments in the state through a regional laboratory network. The state network is one of seven regional networks nationwide. The dissemination of information on cases of antibiotic resistance through shared data has improved resistance surveillance, outbreak response, and communication between health facilities in the state.

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