New study identifies ways hospitals can reduce development of antibiotic-resistant superbugs
By Jess Gomez
Researchers at Intermountain Healthcare and University of Utah Health in Salt Lake City have completed a study identifying how community hospitals with fewer than 200 beds can develop antibiotic stewardship programs to prevent the growth of antibiotic-resistant “superbugs,” which are becoming more common and deadly.
For the 15-month study, researchers compared the impact of three types of antibiotic stewardship programs in 15 small hospitals within the Intermountain Healthcare system. They found that the most effective program used infectious disease physicians and pharmacists at a central hospital working with local pharmacists to reduce broad-spectrum antibiotic use by nearly 25 percent and total antibiotic use by 11 percent.
Researchers found that other programs without central support did not see an improvement in antibiotic use. Results of the new study are published in the medical journal Clinical Infectious Diseases.
All hospitals, no matter how large or small, need antibiotic stewardship programs to help physicians use antibiotics optimally and prevent the growth of antibiotic-resistant superbugs. Until now, it’s been unclear how small community and rural hospitals could build such programs to effectively reduce antibiotic use. Antibiotic stewardship programs are now required in all U.S. hospitals regardless of their size.
Antibiotic resistance, which is accelerated by the overuse of antibiotics, means that bacteria adapt in a way that reduces or eliminates the ability of antibiotics to cure or prevent infections. The bacteria can then turn into antibiotic-resistant superbugs that can cause life-threatening infections. Antibiotics are also responsible for many side effects in patients in the hospital, including Clostridium difficile, or C diff.
Hospitals across the country are required by The Joint Commission to implement antibiotic stewardship programs to improve antibiotic prescribing in hospitals since experts estimate 30 to 50 percent of prescribed antibiotics could be used more effectively or are unnecessary.
For the first time, the participating hospitals had access to infectious diseases physicians via a hotline. This allowed patients to receive expert consultation while remaining in their community.”
— Dr. Eddie Stenehjem Intermountain Medical Center
“Having an antibiotic stewardship program in place that ensures the right antibiotic is used for the right patient, at the right time, in the right dose and route, and for the right duration will help us protect the effectiveness of the antibiotics we use,” said Dr. Eddie Stenehjem, an infectious disease specialist with Intermountain Medical Center and lead author of the study.
“The challenge has been knowing how these programs can be implemented in small hospitals where historically they’ve been absent, even though antibiotic use rates in small hospitals are very similar to large hospitals where the programs are typically found,” he added.
While many smaller hospitals have lacked the resources to build a formal antibiotic stewardship program, researchers determined that using a centralized infectious disease support program decreased overall antibiotic use and the overuse of most broad-spectrum drugs, which are used to target a wide range of bacteria that cause diseases.
Prior to the study, each of the participating hospitals lacked antibiotic stewardship programs. Each hospital was randomly assigned to one of three types of programs to determine which was most effective in reducing broad-spectrum antibiotic use:
Program 1
—Implemented basic education to physicians and staff on antibiotic stewardship programs.
—Provided a 24/7 infectious disease hotline staffed by infectious disease specialists.
Program 2
—Provided more advanced antibiotic stewardship education.
—Provided a 24/7 infectious disease hotline staffed by infectious disease specialists.
—Implemented a pharmacy-based initiative in which local pharmacists reviewed use of broad-spectrum antibiotics and provided recommendations for improvement to prescribers.
—Certain broad-spectrum antibiotics were restricted, and only local pharmacy staff could approve their use.
Program 3
—Provided more advanced antibiotic stewardship education.
—Provided a 24/7 infectious disease hotline staffed by infectious disease specialists.
—Implemented a pharmacy-based initiative in which local pharmacists reviewed most antibiotic prescriptions and provided recommendations for improvement to prescribers.
—Certain broad-spectrum antibiotics were restricted and only centralized infectious diseases pharmacists could approve their use.
—Infectious disease specialists reviewed selected microbiology results and spoke with local providers about recommendations for treatment.
“For the first time, all of the participating hospitals had access to infectious diseases physicians via a hotline,” said Stenehjem. “This allowed the patients to receive expert consultation while remaining in their community.”
Only hospitals in program 3 saw a significant reduction in antibiotic use compared to baseline data. Hospitals in program 3 reduced broad-spectrum antibiotic use by 24 percent and total antibiotic use by 11 percent.
“The bottom line is, small hospitals cannot do it by themselves, but by sharing experts and resources within a system, they can really reduce the inappropriate use of antibiotics,” said Dr. Andrew Pavia, professor of pediatrics at University of Utah Health. “And more appropriate use of antibiotics will help address the growing problem of superbugs that can cause costly and dangerous infections.”
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