Antibiotics provide life-saving treatment; however, approximately 30% of the antibiotic courses given in the US each year are considered inappropriate, commonly prescribed for viral infections such as the common cold. Consequences of antibiotic misuse include allergic reactions; C. difficile, a serious and potentially life-threatening diarrheal illness; and increased antibiotic resistance. There are limited treatment options for those infected with an antibiotic resistant organism, often leading to prolonged hospital stays, increased medical costs and sometimes death. In some parts of the world, infections with organisms that are resistant to almost all current antibiotics including last-line carbapenems are widespread. Given the ease of global travel and the absence of new antibiotics in the pipeline, antibiotic resistance has become a global public health threat.
The National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) strives to slow the emergence of resistant bacteria and prevent spread of resistant infections though more judicious antibiotic use. One method of doing this is for healthcare settings to implement antibiotic stewardship programs (ASP); a set of actions, policies and guidelines that ensure antibiotics are only used when needed and that when they are prescribed, the right drug is given at the right dose and for the right duration. The Centers for Disease Control and Prevention has established Core Elements for ASP that guides inpatient and outpatient healthcare facilities on establishing ASP through implementation of 5-6 domains based on the setting that include drug expertise, education, and antibiotic data tracking and feedback. Currently, hospitals and nursing homes have been mandated by the federal government to establish ASP. This is especially challenging in nursing homes which are often understaffed and lack infectious disease and pharmacy expertise, as well as technological aids such as electronic medical records.
One way to overcome these barriers is for nursing homes to form partnerships with health departments, academic centers, hospitals, etc. For example, the Rochester Nursing Home Collaborative has partnered with several, local nursing homes to provide hospital-based infectious diseases, pharmacy, infection control, and data management expertise to nursing homes. Together, we have created city-wide guidelines and education for testing and treatment of common infectious syndromes that often lead to antibiotic overuse in the elderly, such as urinary tract infections. This partnership benefits not only the nursing home, but the hospital also, as elderly patients often go back and forth between the two healthcare settings. In the future, partnerships like this will be vital for helping resource-strapped healthcare institutions establish ASP and contribute to stopping the spread of antibiotic resistant infections. For more information, please visit www.rochesterpatientsafety.com.