A recent study by Intermountain Healthcare analyzed antimicrobial stewardship programs in 20 different healthcare systems, a starting point for reducing use and preventing the development of superbugs. (Jeffrey D. Allred, Deseret News)
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SALT LAKE CITY – Antibiotics can be extremely helpful in treating infections, but their overuse and overprescription are rapidly reducing their effectiveness and forcing doctors to prescribe stronger antibiotics to treat the same conditions.
Dr. Eddie Stenehjem, Medical Director of Antibiotic Stewardship at Intermountain Healthcare, said Intermountain Healthcare values antibiotic stewardship, having an efficient unified system has become normal for them, but it is not something that the majority of health systems across the country have.
A recent study by Intermountain analyzed antimicrobial stewardship programs in 20 different healthcare systems. These programs help hospitals and systems ensure that antibiotics are used appropriately and attempt to reduce their use to prevent the development of resistance in bacteria.
Stenehjem said the purpose of the study was to raise awareness of what a successful antimicrobial stewardship program looks like, a step towards better stewardship across the country.
This is a starting point to be able to analyze the effectiveness of each model and find what works best to address patient care for each organization, while reducing the development of antibiotic resistant bacteria.
Antimicrobial stewardship programs
Throughout the study, Intermountain Healthcare researchers found that antimicrobial stewardship programs vary widely.
The completed study, which was published in June in a journal called Clinical Infectious Diseases, divided the programs into four categories:
- Collaborative, which has grown organically and is managed by committees and has no formal structure.
- Coordinates at the central level, which have a formal structure and a responsible committee. They often form organically as well, but are used throughout the healthcare system.
- Centrally directed, which have a formal system with leaders, responsibilities, resources, and goals. Here, the tools and technological changes are universal throughout the system and participation is required.
- Collaborative and consultative network, in which leaders outside the organization participate as consultants and sites receive support from across the company.
Intermountain Healthcare most closely resembles the centralized model.
Stenehjem said that once stewardship practices were implemented in Intermountain Healthcare’s 39 urgent care centers in Utah, there was a 50% reduction in the use of antibiotics for respiratory problems.
“It just shows (the impact) that a centrally led program with collaboration and partnership with the urgent care service line…can have because we’re talking about, you know, hundreds of thousands of antibiotic prescriptions not dispensed because of these practices,” said Stenehjem.
Whitney Buckel, Pharmacist Lead for Antimicrobial Stewardship at Intermountain Healthcare, said she often receives questions about Intermountain’s antimicrobial stewardship program from other healthcare systems, and this study allows for better characterization of their program. to help them, and the ability for Intermountain to learn from other programs.
As different methods are found to be more effective, models can be developed for more health care systems.
“We want to advance stewardship everywhere and this is one way to push boundaries and improve antibiotic stewardship nationwide,” Buckel said.
In her role with the Stewardship Program, Buckel does interventions for individual patients who have an infection and have been prescribed antibiotics, suggesting a better antibiotic for a specific culture, no antibiotics or a shorter duration.
Buckel explained that they are not trying to find the best system and recognize that the ideal system for antimicrobial stewardship may vary depending on the healthcare system or hospital. However, more information about what works and more systems putting resources into ensuring that antibiotics are used appropriately can have a big impact on antibiotic effectiveness.
Superbugs?
As diseases evolve to fight antibiotics, antibiotic-resistant superbugs form that cannot be treated with current antibiotics.
Because bacteria don’t spread through the air like viruses, antibiotic-resistant diseases won’t lead to another pandemic like COVID-19, but superbugs still have serious consequences as it becomes increasingly difficult to treat them.
Buckel explained that the American population used a lot of “Z-packs”, a standard treatment of azithromycin antibiotics, but that because of the frequency with which they were used, the Z-packs did not work as much anymore. good for everyone, not just for people who have used them, but because bacteria have developed resistance.
She also said that some sexually transmitted diseases that were previously treated with a pill now require an injection because the pills are no longer effective.
“It’s kind of an escalation,” Buckel said.
Stenehjem said the types of infections that may not be able to be treated with medication are urinary tract infections, pneumonia and other infections that are not very transmissible but can be very serious.
During the COVID-19 pandemic, there was more data on the increase in multi-drug resistant organisms, and new antibiotics are not being created fast enough to match the rate of drug resistance.
“We will continue to see more and more patients develop infections with completely drug-resistant pathogens, which we don’t have antibiotics to treat,” Stenehjem said.
What’s next for research?
Buckel said every health system is currently required to have an antibiotic stewardship program, so many have implemented a minimal program and electronic health records have also enabled health systems to do something more. easily. However, much more needs to be done to improve programs and help them effectively reduce antibiotic use.
Thanks to the network of experienced people working on this study, she said she was able to talk about how to start an antimicrobial stewardship program in a new organization and what positions are needed for an organization that is just getting started.
Stenehjem said many organizations look at antibiotic management in a hospital, but not across the entire healthcare system. He said the majority of antibiotics are used on an outpatient basis, in clinics or doctor’s offices, and that including outpatient services in a stewardship program allows the program to really affect community antibiotic consumption.
“(Including ambulatory systems) is really going to influence the health of the population, and it’s a public health issue because of the development of drug resistance and superbugs,” Stenehjem said.
This study focused primarily on inpatient care and further research may extend to antibiotic prescriptions in outpatient settings, including doctors’ offices and clinics.
Research in this area will continue, although it may be conducted by other organizations. The Pew Charitable Trusts, which contributed to this study, hosted a meeting in Utah with stewardship experts in September to specifically discuss outpatient antimicrobial stewardship.
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