{"id":4790,"date":"2016-05-11T00:00:00","date_gmt":"2016-05-11T06:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/05\/11\/uch-antibiotic-stewardship-conference-targets-the-meds-that-battle-the-bugs\/"},"modified":"2024-07-17T09:27:25","modified_gmt":"2024-07-17T15:27:25","slug":"uch-antibiotic-stewardship-conference-targets-the-meds-that-battle-the-bugs","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/uch-antibiotic-stewardship-conference-targets-the-meds-that-battle-the-bugs\/","title":{"rendered":"UCH antibiotic stewardship conference targets the meds that battle the bugs"},"content":{"rendered":"
<\/div>
Arjun Srinivasan, MD, of the CDC presented a national update on antibiotic stewardship to representatives of more than two dozen Colorado hospitals at UCH on May 6.<\/figcaption><\/figure>\n

For decades, medical science has waged war against the bacteria that have long bedeviled mankind. That fight goes on, but it\u2019s taken on an ironic new dimension. The antibiotics that gave medical providers the upper hand in battling infectious diseases have in many cases made the job more difficult.<\/p>\n

The problem is widespread overprescribing of antibiotics. These medications save lives and limbs, but they can wreak havoc if they are administered indiscriminately or for too long a time. In such cases, antibiotics can wipe out bacteria in the gut that people need \u2013 opening the door to dangerous infections, like Clostridium difficile<\/em><\/a>\u00a0<\/a>(C. diff<\/em>) \u2013 and encourage the evolution of ever-more resistant strains that menace public health and require more powerful antibiotics that can cause separate health problems.<\/p>\n

The threat is real, as increasing rates of C. diff<\/em> in Colorado and elsewhere and outbreaks of highly resistant infections attest. It\u2019s drawn intense attention from the Centers for Disease Control and Prevention<\/a> and the White House<\/a>. That\u2019s not surprising, considering that the total economic burden of treating patients with antibiotic-resistant infections has been estimated at<\/a>\u00a0between $20 billion and $35 billion. A recent study<\/a> from the CDC and the Pew Charitable Trust concluded that one in three antibiotic prescriptions written is unnecessary.<\/p>\n

The concern is shared by state public health officials and medical providers across the country, including a collaborative of 27 hospitals in Colorado whose representatives gathered at University of Colorado Hospital May 6. They convened for a Colorado Hospital Association (CHA) conference on antimicrobial stewardship \u2013 the safe and responsible administration of antibiotics.<\/p>\n

Effort rewarded<\/strong><\/p>\n

\"Srinivasan
Srinivasan and Teri Hulett, RN, program manager for infection prevention for the Colorado Hospital Association, during a conference break.<\/figcaption><\/figure>\n

The group forms CHA\u2019s \u201cAntimicrobial Stewardship Collaborative,\u201d which came together a year ago. The effort focuses on raising the awareness in hospitals of the importance of managing antibiotic prescribing and finding ways to make antibiotic stewardship a part of everyday clinical practice.<\/p>\n

In its first year, the collaborative concentrated on antibiotic prescribing for urinary tract infections (UTIs), skin and soft tissue infections, and on more accurate diagnosis of UTIs \u2013 an important part of preventing overprescribing of antibiotics.<\/p>\n

The stewardship collaborative focused in its first year on reviewing infection cases, gathering data, and sharing information between hospitals, said Gerry Barber, RPh, MPH, coordinator of Pharmacy and Therapeutics and Clinical Pharmacy Services at UCH. Barber and Heidi Wald, MD, MPH, vice chair for quality for the CU School of Medicine\u2019s Department of Medicine, serve on the steering committee for the collaborative.<\/p>\n

In the first year, the member hospitals shortened median use of antibiotics for skin infections by one day. \u201cWe\u2019re now beginning to show the fruits of our labor,\u201d Barber said.<\/p>\n

A single-day, across-the-board decrease in the duration of antibiotic administration can have a significant effect on public health, Barber said.<\/p>\n

\u201cIf you think about all the patients admitted to this hospital, let alone all of them in Colorado, one less day of antibiotic therapy means hundreds, if not thousands, fewer days patients are on these medications,\u201d he said. Taking those antibiotics out of the hospital environment, he added, reduces the opportunities for bacteria to adapt and become antibiotic-resistant, he added.<\/p>\n

\u201cIt\u2019s axiomatic that if you treat one patient with antibiotics, you\u2019re treating all patients, because you are changing the environment in which bacteria live,\u201d Barber said.<\/p>\n

The collaborative will sharpen its focus on managing antibiotic treatment of UTIs, Barber added. \u201cWe clearly have room for improvement in that area,\u201d he said.<\/p>\n

Looking for leadership<\/strong><\/p>\n

\"Panelists\"
Candice Allen, chief nursing officer of Rio Grande Hospital in Del Norte (far left), speaks during a panel discussion on efforts to implement antibiotic stewardship programs at Colorado hospitals. She\u2019s joined by (from left) Ri Holbrook, PharmD, Longmont United Hospital; Sheila Nees, MD, St. Mary\u2019s Hospital and Medical Center; and Jeff Desjardin, MD, Lutheran Medical Center.<\/figcaption><\/figure>\n

A key for hospitals looking to develop a strong antibiotic stewardship program is leadership that provides expertise and education, drives collection and reporting of data, and makes providers accountable for their clinical decisions, said Arjun Srinivasan, MD, of the CDC. Srinivasan gave conference attendees a national update on antimicrobial stewardship.<\/p>\n

Large hospitals, especially teaching institutions, are more likely to have these \u201ccore elements\u201d of stewardship in place, Srinivasan said. At UCH, for example, Norihiro Yogo, MD, director of antimicrobial stewardship, and Matt Miller, PharmD, an infectious disease pharmacy specialist, have developed guidelines for treating common infections, including those of the skin and UTIs. But Srinivasan noted that some 100 critical-access hospitals that serve mainly rural areas\u00a0across the United States incorporate all the necessary core elements of a strong stewardship program.<\/p>\n

\u201cSmaller hospitals are finding ways to get this done,\u201d Srinivasan said.<\/p>\n

One of those paying close attention to managing antibiotics is Rio Grande Hospital, a 17-bed facility in Del Norte, Colo. Candice Allen, RN, MS, the hospital\u2019s chief nursing officer, joined a four-provider \u201cstewardship panel\u201d moderated by Srinivasan at the May 6 meeting. Allen said Rio Grande\u2019s 13 providers, including its nurses, \u201cjumped on board\u201d to join the work of the collaborative.<\/p>\n

\u201cI was surprised at how well everyone embraced it,\u201d Allen said. She noted that Rio Grande\u2019s stewardship strategy centers on collecting data that helps providers understand \u201cwhat we are doing and why\u201d and developing clinical pathways and order sets to guide antibiotic prescribing.<\/p>\n

The work\u00a0also includes explaining to patients why it\u2019s okay not to order tests, such as urine cultures for asymptomatic bacteriuria \u2013 the presence of bacteria in the urine without symptoms or signs of a UTI. Treating bacteriuria with antibiotics is an important contributor to antibiotic resistance.<\/p>\n

\u201cWe are comfortable telling patients, \u2018It\u2019s okay that we don\u2019t do a culture. You\u2019re asymptomatic,\u201d Allen said.<\/p>\n

The collaborative has extended its work to other providers. For example, 25-bed Southwest Memorial Hospital in Cortez, Colo., part of the Southwest Health System (SHS), has joined with the CHA to help eight long-term care facilities in the area develop antibiotic stewardship programs, said Marc Meyer, RPh, a pharmacist and infection preventionist with SHS.<\/p>\n

The project included a day-long conference in late March with presentations by Wald and a CDC medical epidemiology expert. \u201cWe\u2019ve challenged ourselves to think outside of the walls of the hospital and get into the community,\u201d said Meyer.<\/p>\n

Time to get on board<\/strong><\/p>\n

It\u2019s vital that hospitals, whatever their size, focus attention on how they administer antibiotics, the conference participants agreed. For one, Colorado has seen an increase in the incidence of C. diff<\/em>, a gut-dwelling, toxin-producing bacterium that causes severe diarrhea and colitis and is especially dangerous to already weakened patients, such as the elderly and the immunocompromised. Overprescribing antibiotics opens the door to C. diff<\/em> by wiping out \u201cgood bacteria\u201d and allowing the rogue intruders to take over.<\/p>\n

Wendy Bamberg, MD, of the Colorado Department of Public Health and Environment, noted that there were 3,600 cases of C. diff<\/em>. in the Denver metro area alone each year from 2010 to 2014.<\/p>\n

\u201cThe number is trending up,\u201d she said. \u201cThe Antibiotic Stewardship Collaborative is an important part of C. diff<\/em> infection prevention in this state.\u201d<\/p>\n

Hospitals that solidify their stewardship programs now will not only protect their patients and public health; they also will be ahead of the health care curve, Srinivasan added. He noted that the Centers for Medicare and Medicaid Services has proposed that antibiotic stewardship programs be a \u201ccondition of participation\u201d for long-term care facilities. The same requirement could be coming for hospitals, Srinivasan said. If it does, the Joint Commission, which \u201cechoes\u201d CMS regulations, would likely include stewardship programs in its accreditation criteria, he said.<\/p>\n

\u201cCMS is signaling to the world that it is considering antibiotic use as a condition for payment,\u201d Srinivasan said. \u201cIt is putting a marker down.\u201d<\/p>\n

Despite the progress and the urgency of continuing it, much work remains to be done to change a health care system that continues to rely heavily on antibiotics in patient care \u2013 often justifiably so, Barber said.<\/p>\n

\u201cThe biggest challenge is changing practice,\u201d he said. \u201cWe have a wide group of providers and they all want to do what is best for the patient. But we have reached a critical point in the number of antibiotics we give patients. We now often need broader-spectrum, more expensive and more toxic agents. We need stewardship programs that minimize the collateral damage that can be caused by antibiotics.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

For decades, medical science has waged war against the bacteria that have long bedeviled mankind. That fight goes on, but it\u2019s taken on an ironic new dimension. The antibiotics that gave medical providers the upper hand in battling infectious diseases have in many cases made the job more difficult. The problem is widespread overprescribing of […]<\/p>\n","protected":false},"author":2143,"featured_media":2609,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[73,233,63,2683],"class_list":["post-4790","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-antibiotics","tag-antimicrobial-stewardship-collaborative","tag-pharmacy","tag-u-s-centers-for-disease-control-and-prevention"],"acf":[],"yoast_head":"\nUCH antibiotic stewardship 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