Antimicrobial Stewardship: Preserving the Future
Antimicrobials were an amazing discovery and have been appropriately credited, along with vaccination and sanitation, with the significant improvements in human life expectancy over the last century. With their amazing impact has come the opportunity for new therapies including organ transplant, complex surgery, and care for extremely preterm infants. The success of these medical interventions is founded upon the ability to treat the inevitable infections which develop with highly effective and safe antimicrobials. Unfortunately, we now live in an era where the utility of these amazing agents is threatened by the emergence and spread of antimicrobial resistance.
Antimicrobial resistance is a growing worldwide problem. The CDC highlighted this in their Antibiotic Resistance Threat Report, which estimated at least 2 million people become ill and 23,000 die from antibiotic-resistant infections each year. The key driver of antimicrobial resistance is antimicrobial use which eliminates susceptible pathogens leaving only those which are resistant to grow and expand. Antimicrobial use in both humans and animals can promote resistance and resistant pathogen infections are associated with worsened clinical and economic outcomes. One group estimated that if antimicrobial resistance is left unchecked, by the 2050 it would kill more persons yearly than cancer.
Compounding the issue of resistance is the fact that the antimicrobials used in hospitals, ambulatory clinics, and long-term care facilities (LTCF) are often inappropriate or unnecessary. Inappropriate antimicrobial use results in worsened patient outcomes, toxicity including C. difficile infection, and increased cost. To mitigate these issues the CDC has recommend facilities of all types institute antimicrobial stewardship programs. Antimicrobial stewardship programs employ strategies or processes designed to help clinicians decide if an antimicrobial is necessary and if so what agent, dose, and duration is optimal. The CDC states, “Antimicrobial stewardship interventions have been proven to improve individual patient outcomes, reduce the overall burden of antibiotic resistance, and save healthcare dollars.” Implementation of antimicrobial stewardship programs offer the advantages of making patient care safer, more effective, more efficient, and often less expensive.
The CDC and the State of Nebraska have appointed this week as 2017 US Antibiotic Awareness Week, and so over the next five days, we will be highlighting the ongoing antimicrobial stewardship activities at the University of Nebraska Medical Center (UNMC) and Nebraska Medicine (NM). We will describe the successes of the NM Program, which has been promoting improvements in antimicrobial use for over a decade. We will also explain the role the Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP), a partnership between NM, UNMC and the State of Nebraska, has had in promoting stewardship in smaller hospitals, LTCF, and ambulatory settings. Finally, we will be highlighting some of the strategies and activities that are effective in improving antimicrobial use and with each post, introducing you to some key members of our stewardship teams.