The Impact of Social Media on Antimicrobial Stewardship Programs: Background on the Management of Drug-Resistant Bacterial Infections

Contagion, December 2018, Volume 3, Issue 6

Dr. Goff and Mr. Nosta discuss how to use Twitter to communicate about infectious diseases and antimicrobial stewardship.

Social media is emerging as a new platform to educate and engage health care professionals and the community on the appropriate use of antimicrobial agents, with goals of optimizing patient outcomes and addressing the increase in antimicrobial resistance, according to panelists who participated in a Contagion® Insights panel.

“I look at social media, why is it important to me as a clinician,” said Debra Goff, PharmD (@idpharmd). “There are so many reasons. It gives me the opportunity to engage, educate, connect, [and] network with experts and consumers and patients around the world. That’s an opportunity that no other vehicle provides.”

Prior to discussing the use of social media for promoting antibiotic stewardship, Dr. Goff and John Nosta, BA, (@JohnNosta) summarized current issues related to educating health care providers and the general public on appropriate management of bacterial infections, including the inappropriate prescription of antibiotics to appease patients and treat asymptomatic colonized bacteria, as well as ways to change antibiotic prescribing practices among physicians.

INAPPROPRIATE PRESCRIPTION OF ANTIBIOTICS

Dr. Goff and Mr. Nosta acknowledged that the complexities of antimicrobial stewardship can be difficult to communicate to health care providers and patients alike.

“If it was as simple as reading a guideline or an article, the world would be successful,” Dr. Goff said. “We have made great progress, but we do not have everybody fully engaged, because it is so complex. It is not just the health care provider that needs to be onboard. We need to have patients onboard.”

She and Mr. Nosta acknowledged that some physicians may prescribe antibiotics inappropriately in the outpatient setting to keep high rates of patient satisfaction and good online ratings. “The satisfaction score a patient provides to a physi­cian is often a function of getting the script,” Mr. Nosta said.

Over 30% of antibiotics prescribed in the outpatient setting are unnecessary, according to the results of a 2016 JAMA study that analyzed data from the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (see Table).1 Dr. Goff noted that physicians often unneces­sarily prescribe antibiotics for asymptomatic, uncomplicated urinary tract infections that are actually colonized bacteria.

“[Presence of] asymptomatic bacteria is the most common overuse and misuse [symptom] of an antibiotic in the hospital setting,” Dr. Goff said. “[Physicians] feel compelled to treat a lab result, but it is not that simple. You have to look at the patient and put the whole clinical scenario together.”

She added that patients with mild symptoms of an infec­tion may also request an antibiotic prescription because they believe it will make them feel better, even if the infection is not confirmed to be bacterial. “For respiratory tract infec­tions, if [patients] come in sniffling and sneezing and [they] want an antibiotic because they think that is what is going to treat them, more than likely the physician’s going to give them the antibiotic,” Dr. Goff explained. “It’s sort of feel-good medicine. I’m going to make you happy, and you’re going to like me, and therefore, I’m going to do this. But it is actually inappropriate if they do not have a bacterial infection.”

CHANGING PRESCRIBING PRACTICES AMONG PHYSICIANS REQUIRES EFFECTIVE COMMUNICATION

Dr. Goff and Mr. Nosta discussed how antibiotic stewardship requires behavioral changes among physicians, which goes beyond instructing appropriate use of antibiotics and can be difficult when physicians have been practicing for decades.

“If I’m talking to a surgeon and I’m trying to tell them, ‘No, you cannot have this new antibiotic because you have to call me, and I have to approve it,’ right away you set up a brick wall,” Dr. Goff said. “Nobody likes to be told, ‘I have to have your approval to do something that I think I’m an expert in.’ We have to change the way we operate. It is not as simple as, ‘Here’s a set of guidelines,’ and everybody is supposed to follow them. You are not going to follow a guideline if you don’t understand why I am asking you to do this.”

Mr. Nosta and Dr. Goff discussed whether the mistreat­ment of an infection with a high mortality rate, such as nosocomial pneumonia, is more problematic than mistreat­ment of an infection with a lower mortality rate but broader consumer implications, such as a urinary tract infection. Dr. Goff concluded that all misused antibiotics, whether inappro­priately prescribed or incorrect for the infectious organism, contribute to the growing problem of resistance. In the hospital setting, selecting the wrong antibiotic is a key contributor to the development of drug-resistant infections, whereas antibi­otics prescribed in the outpatient setting are often stopped prematurely when the patient feels better. However, Dr. Goff also noted that the prescribed durations for antibiotic regi­mens are often not well supported by data.

“Patients, when you give them an antibiotic prescription, generally stop it when they feel better and save it for next time,” she said. “But we have actually learned they might be right. When you look at the evidence of how that duration came to be, there’s [no] good data.”

Dr. Goff also added the importance of ensuring that repre­sentatives from pharmaceutical companies are consistent with the recommendations given by pharmacists who educate physicians at a given hospital or practice.

“They might have an antibiotic that has 5 US Food and Drug Administration—approved indications,” Dr. Goff explained. “But at my hospital, I only want it used for this 1 indication. We partner, and they are an extension of our marketing to our own physicians. It is the best way, because I match it with what our organisms are in our hospital, and that differs everywhere.”

Dr. Goff also emphasized the importance of collaboration between clinical pharmacist and physician to promote anti­biotic stewardship. “If I go and try to tell my surgeons, ‘You cannot do this any longer,’ and I just give them a set of rules, I already know that’s not going to work…unless they under­stand [the] motivation. Bring them to the table…whether it be surgeons, the hospitalist, the critical care physician, and say, ‘Here’s the problem. We have this escalating antimicrobial resistance in your unit.’ I bring factual data: ‘Here are the last 100 patients we have treated, and here has been their outcome with the antibiotic you’ve been selecting. We have to make a game change, and this is what I’m recommending,’ and I stop and listen to them,” Dr. Goff said.

She concluded that knowing the best ways to effectively communicate with each physician is critical for delivering information about antibiotic stewardship. In her experience, surgeons tend to want “sound bites” of which antibiotics to prescribe and why, whereas hospitalists often want to know more detailed information about why an antibiotic might be best.

“Every physician has [his/her] own personality style, and you’ve got to know that type of style to be most effective,” she said.

She and Mr. Nosta then went on to discuss how they use Twitter to communicate about infectious diseases and antibi­otic stewardship to a wide base of individuals, from surgeons and hospitalists who treat patients with drug-resistant infec­tions to celebrities who may be personally affected by these infections. More on this topic will be discussed in the February 2019 issue of Contagion®.

References

1. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315(17):1864-1873. doi: 10.1001/jama.2016.4151.