Author – Arjun Srinivasan, MD
CDC – Medical Director, Get Smart for Healthcare Program
Over the past 2 years, I have brought together experts on antibiotic resistance to discuss how CDC can assist in efforts to improve antibiotic use in hospitals and nursing homes. My colleagues have published numerous studies demonstrating that inappropriate antibiotic use in hospitals and nursing homes results in increased resistance, worse patient outcomes, and increased costs. It is also helping drive the national epidemic of Clostridium difficile infections. This year, we have watched as deadly new mechanisms of antibiotic resistance were discovered in U.S. hospitals, mechanisms that will undoubtedly challenge our healthcare system and affect patient safety (see NDM-1, VIM). Clearly, we have a serious problem.
Those initial discussions with colleagues resulted in an expansion of CDC’s Get Smart programs, which target antibiotic use in outpatient clinics and pediatrician’s offices, to include a comprehensive program targeting inpatient settings. This week, CDC launched the Get Smart for Healthcare program aimed reducing inappropriate antibiotic use in hospitals and nursing homes. The foundation of this program is the concept that everyone plays a role in improving antibiotic use.
Healthcare providers – following 3 simple steps will ensure you are prescribing antibiotics wisely and help promote efforts to optimize use. First, all orders must contain a dose, duration, and an indication. Secondly, when placing orders, make certain that they include laboratory cultures. And finally, when your culture results come back in 24-48 hours, take an antibiotic time-out – reassess therapy. With this additional information, ask yourself – Is this antibiotic still warranted or, more importantly, is this antibiotic still effective against this organism? (See Dr. Srinivasan on Medscape.)
Healthcare administrators and payers — Interventions to improve antibiotic use can be done in any setting. Every facility – regardless of setting and hospital size – should emphasize and implement antibiotic stewardship. Administrators play a key role in supporting these efforts and helping send the message that optimal antibiotic use is an important patient safety issue. Antibiotic stewardship helps improve patient care and shorten hospital stays, thus benefiting patients as well as the hospitals. It is a “win‐win” for all involved, especially as payments are increasingly tied to quality.
Patient and caregivers – Ask questions. Ask your healthcare provider – Why do I need this antibiotic? What will this antibiotic treat? How long will I have to be on this antibiotic? What are the side effects?
Antibiotics are a shared resource; for some infections, they are a scarce resource. The solution cannot be to solely focus on developing new drugs. New antibiotics are a long way off and even when we have them, they might not be the panaceas we are hoping for. But most importantly, if we don’t act now to improve the way we use antibiotics, we will quickly lose any new drugs we’re lucky enough to get. It’s time for us all to act to improve antibiotic use.