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The Power of Antibiotic Stewardship in Patient Care

Categories: Antibiotic use, Healthcare-associated infections

Don Goldmann, MD

Don Goldmann, MD

Author: Don Goldmann, MD
Chief Medical and Scientific Officer
Institute for Healthcare Improvement
Clinical Professor of Pediatrics
Harvard Medical School
Professor of Immunology and Infectious Diseases, and Epidemiology
Harvard School of Public Health

For the past several years, IHI has been actively engaged in working with a wide variety of acute care hospitals in partnership with the Centers for Disease Control and Prevention (CDC) and other national experts to advance antibiotic stewardship. Our overarching goal is to reduce adverse drug events related to inappropriate antibiotic utilization, the prevalence of antibiotic resistance, the risk of Clostridium difficile infection, and the cost of care.

We developed a framework for reducing inappropriate antibiotic utilization and a set of key practical change concepts and related metrics that caregivers could implement as part of their routine work at the bedside. These recommendations were designed to support hospitals across the US (regardless of size, acuity, or geographic location) in their efforts to curb unwarranted antibiotic utilization. A key learning from initial testing of the framework in a group of pilot hospitals emphasized the power of stewardship when relatively simple practices are incorporated into the everyday work of hospitalists and care teams, preferably in collaboration with pharmacists.

IHI’s upcoming Expedition on Antibiotic Stewardship will spread what we learned in this initial testing to help other hospitals create a more reliable system for sound antibiotic prescribing. The Expedition is designed to support hospitals where they are currently — whether they are just starting to implement stewardship or are hoping to accelerate improvement in their existing programs. Specific interventions that have been particularly successful will be highlighted, including:

  • An “antibiotic time out” — a pause at 48 to 72 hours to review the indication and expected duration of antimicrobial therapy, and make appropriate adjustments or discontinue treatment based on available clinical data; and
  • Use of multidisciplinary rounds to engage all team members in antibiotic stewardship goals, opportunities for improvement, and action.

IHI’s Expedition can help identify and begin improving key processes to optimize antibiotic selection, dose, and duration in their patient care setting and share additional strategies for effectively incorporating antibiotic stewardship into existing patient care processes.

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. March 18, 2014 at 11:18 am ET  -   CDC's Safe Healthcare Blog

    CDC recommends that all hospitals implement an antibiotic stewardship program to improve antibiotic prescribing. Each facility should create its own stewardship team to learn about and share antibiotic resistance patterns in the facility and in the surrounding community. The team’s expertise can be used to target patient therapies regarding specific pathogens based on this information. Stewardship programs do not have to add financial burden; in fact, they have been shown to save money. CDC also recommends that facilities close to each other work together to share resistance information and to develop a coordinated strategy to prevent and address drug resistance.

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  2. March 10, 2014 at 5:16 pm ET  -   Rodrigo Uribe P

    There has been mutation variation and antibacterial resistance within a same bacteria over different cities. Taking this into consideration, many experts debate if it’s cost-effective to develop new practical antibiotic-therapy guidelines for each region or ‘grouped cities’. New culture collections and antibiotic effects for different bacterias should be performed to differ the resistant and non-resistant bacterias, and to which antibiotics. What do you think of this? Necessary, very much!! Cost-effective??? Please, any comment is very welcome.

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