A recent study led by Intermountain Healthcare analyzed antimicrobial stewardship programs in 20 different health care 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 incredibly useful for treating infections, but overuse and overprescribing are quickly reducing their effectiveness and requiring doctors to prescribe stronger antibiotics to treat the same conditions.
Dr. Eddie Stenehjem, medical director of antibiotic stewardship at Intermountain Healthcare, said because Intermountain Healthcare values antibiotic stewardship, having an effective unified system has become normal for them, but it’s not something most health systems in the U.S. have. the whole country.
A recent study led by Intermountain analyzed antimicrobial stewardship programs in 20 different health care systems. These programs help hospitals and systems ensure that antibiotics are being used appropriately and try to reduce their use to prevent the development of resistance in bacteria.
Stenehjem said the goal of the study was to raise awareness of what a successful antimicrobial stewardship program looks like, a step toward better stewardship across the country.
It 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, reducing the development of bacteria that are resistant to antibiotics.
Antimicrobial stewardship programs
Throughout the study, Intermountain Healthcare researchers found that antimicrobial stewardship programs vary significantly.
The completed study, which was published in June in a journal called Clinical Infectious Diseases Divide the programs into four categories:
- Collaboratives, which have developed organically and are run by committees and do not have a formal structure.
- Centrally coordinated, which have a formal structure and an accountable commission. They are often formed organically as well, but are used throughout the health care system.
- Centrally managed, which have a formal system of leaders, accountability, resources and goals. Here, technological tools and changes are universal throughout the system and participation is required.
- Collaborative, consultative network, which has leaders from outside the organization participating as consultants, and sites receive support from the wider company.
Intermountain Healthcare most closely resembles the center-led model.
Stenehjem said that once the stewardship practices were implemented at Intermountain Healthcare’s 39 urgent care centers in Utah, there was a 50% reduction in the use of antibiotics for respiratory issues.
“It just goes to show (the impact) a centrally-led program in collaboration and partnership with the urgent care service line … can have because we’re talking about, you know, hundreds of thousands of antibiotic prescriptions that aren’t filled because of these practices. “- said Stenehjem.
Whitney Buckel, pharmacist manager of antimicrobial stewardship at Intermountain Healthcare, said she often receives questions about Intermountain’s antimicrobial stewardship program from other health systems, and this study allows a better characterization of their program to help them. them and the ability for Intermountain to learn from others. programs.
As different methods are determined to be more effective, models can be developed for more health care systems.
“We want to push stewardship forward everywhere, and this is one way to push the envelope and improve antibiotic stewardship nationally,” Buckel said.
In her role with the stewardship program, Buckel makes interventions for individual patients who have an infection and have been given 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 acknowledges that the ideal system for antimicrobial stewardship may vary based on the health care system or hospital. However, more information about effective methods and more systems that commit resources to ensure that antibiotics are used appropriately could have a major impact on the effectiveness of antibiotics.
Superbugs?
As diseases evolve to combat antibiotics, antibiotic-resistant superbugs form that cannot be treated with current antibiotics.
Because bacteria don’t spread through the air like viruses, diseases that are resistant to antibiotics won’t bring about another pandemic like COVID-19, but superbugs still have serious consequences as they become increasingly difficult to treat.
Buckel explained that the American population used to use a lot of “Z-packs,” a standard course of the antibiotic azithromycin, but because of their frequency of use, Z-packs now don’t work as well for everyone, not just people who have used them. , but because the bacteria have developed a resistance.
She also said that some STDs that used to be treated with a pill now need an injection because the pills are no longer effective.
“It’s kind of an escalation,” Buckel said.
Stenehjem said the types of infections at risk of not being able to be treated with drugs are urinary tract infections, pneumonia and other infections that are not highly contagious but can be very serious.
During the COVID-19 pandemic, there was more evidence of highly drug-resistant organisms on the rise, and new antibiotics are not being developed fast enough to match the rate of drug resistance.
“We will continue to see more patients developing infections with completely drug-resistant pathogens that we don’t have antibiotics to treat,” Stenehjem said.
What’s next for research?
Buckel said every health care system is currently required to have an antibiotic stewardship program, so many have implemented a minimal program, and electronic health records have also made it easier for health systems to do something. However, there is still much to be done to improve programs and help them become effective in reducing antibiotic use.
Through the network of experienced people working on this study, she said they were able to talk about how to start an antimicrobial stewardship program in a new organization and what positions are needed for an organization just starting out.
Stenehjem said many organizations consider administering antibiotics in a hospital, but not across the health care system. He said most antibiotics are used in an outpatient setting, in clinics or doctors’ offices, and incorporating outpatient services into a stewardship program allows the program to actually impact antibiotic consumption in the community.
“(Including ambulatory systems) is really going to affect 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 could be extended to antibiotic prescribing in ambulatory settings, including physician offices and clinics.
Research in this area will continue, although it may be led by other organizations. The Pew Charitable Trusts, which helped with this study, organized a meeting in Utah with stewardship experts in September to specifically discuss antimicrobial stewardship in ambulatory settings.
