Make the case for investing staff, resources in antimicrobial stewardship
Emphasize saving lives more than cost savings
Hospital pharmacists should push their organizations to initiate the strongest antimicrobial stewardship programs possible because the alternative is to see an increase in patients with bacterial infections that cannot be cured.
By collecting some data about antimicrobial use and the rates of drug resistance, it should be easy to demonstrate the need for such a program, says Debra A. Goff, PharmD, FCCP, a clinical associate professor at the Ohio State University College of Pharmacy in Columbus, OH, and an infectious diseases specialist at the Ohio State University Medical Center.
For instance, a pharmacist at a hospital that because of the prevalence of multidrug-resistant infections has begun to use the old antimicrobial colistin could make an easy case for the need of a strong and proactive antimicrobial stewardship program, Goff says.
The antimicrobial colistin fell out of favor decades ago because of toxic side effects.
"The best surrogate marker for having a drug resistance problem is how much colistin you've been using at your hospital," Goff says. "If you've never used it, and then this year you've had to use it, then there's a problem."
The Ohio State University Medical Center receives many patients with multidrug-resistant infections from other hospitals, which increases need for antimicrobial stewardship, Goff says.
"I've tracked our colistin use for the past three years, and it's increasing year by year," Goff says.
"That's what made our administration receptive to funding our program," she adds. "When you have no effective therapy except a drug from the 1960s, then they clearly understand there's a big problem."
Even worse, in countries where colistin has continued to be used for years, there is a high rate of resistance to this treatment.
"In Korea, there is 30% resistance to colistin," Goff says. "Once we lose that drug, then we will have no effective therapy for some patients."
U.S. hospitals in large urban areas or that are located near military bases also need a strong antimicrobial stewardship program because of increases in cases of Acinetobacter baumanni, which has been called the Iraq War bug. The soil-borne pathogen with inherent drug resistance has been brought back to the states by soldiers who suffered bombing and other injuries while serving duty in Iraq, Goff says.
"It's an organism you rarely saw in a hospital, and now it's a frequent occurrence," she says. "American soldiers get it in their wounds, and then they come back to the United States for long-term care, and they bring the organism into our hospitals."
The pathogen can cause pneumonia, blood poisoning, and other infections, and it can go undetected in hospitals, while spreading easily from one patient to the next.
These are the kinds of problems that hospitals could not have anticipated or prevented, Goff notes.
But with an antimicrobial stewardship program that has ample resources, unforeseen emergencies can be contained.
"These things walk in your door, and it's up to you to quickly identify a multidrug-resistant pathogen," Goff says. "Then we make sure everyone understands this is a virulent, multidrug-resistant organism and they need to make sure hand hygiene is taking place and make sure housekeeping is aware."
When hospitals begin an antimicrobial stewardship program that includes a pharmacist reviewing antibiotic use, there often is a financial benefit initially.
"We're nine months into our program, and we've seen a cost savings in antimicrobial use by de-escalating broad-spectrum antibiotics," Goff says. "Our pharmacists make daily interventions, and we monitor specific antibiotics daily."
Pharmacists make recommendations and then track the acceptance rate of their recommendations, she adds.
"Our annualized savings for the first year was $296,000," Goff says. "We exceeded our expectations."
However, pharmacists need to make certain hospital leaders do not expect an antimicrobial stewardship program to produce those cost savings every year, she notes.
"That's not something that you can sustain from year to year, and the administration needs to have a clear understanding of that," Goff explains. "The reality in 2009 is that if you have multidrug resistance, then you have to use two or three antibiotics to treat a patient, instead of only one, so the cost-savings as a long-term goal is not a realistic goal."
Hospital administrators often will say they'll start an antimicrobial stewardship program and hire new staff for it, so long as the program's new salaries are offset by cost savings, Goff says.
"But that's not realistic long term," she adds. "You'll be using new antibiotics when the old ones don't work."
The true value of a stewardship program is its ability to improve patients' quality of life and to decrease the incidence of multidrug resistance in the hospital and community, Goff adds.
Hospital pharmacists should push their organizations to initiate the strongest antimicrobial stewardship programs possible because the alternative is to see an increase in patients with bacterial infections that cannot be cured.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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