Antibiotic-Preserving Strategies Must Be Implemented to Battle Resistance

Modern medicine is largely dependent on the efficacy of antibiotics and other antimicrobials. Yet the ability to treat infections successfully with antibiotics is hampered by resistance due to their overuse and misuse.  Well-documented and properly coordinated strategies like stewardship of antibiotics, expanded surveillance of antibiotic resistance, as well as investment in new drug development and diagnostic testing can work to reverse this alarming trend. The Society for Healthcare Epidemiology of America (SHEA) is pleased to join the Centers for Disease Control and Prevention (CDC) and other partners in "Get Smart about Antibiotics Week" to raise awareness of strategies and programs to address antibiotic resistance.

"Antimicrobial resistance is a complex global issue that impacts the practice of medicine today,” says Anthony Harris, MD, MPH, president of the SHEA board of trustees. “The United States has identified a set of proven strategies and recommendations to address antibiotic resistance. The key to success lies in implementation.  We need adequate resources, strong governmental coordination, support of research and development, and external stakeholder involvement to make headway in the fight to preserve life-saving antibiotics."

"All healthcare facilities can improve patient outcomes and antibiotic resistance trends by focusing on efforts to eliminate unnecessary antibiotic therapies and raising the patients' understanding of this issue,” says Sara Cosgrove, MD, MS, chair of SHEA's Antimicrobial Stewardship Committee.  “Implementing comprehensive programs to help providers optimize antibiotic use across healthcare settings is of great importance. At the same time, we must educate and engage patients in understanding when antibiotics are needed and when they are not.”

Through SHEA, the healthcare epidemiology profession, which includes hospitals’ infection control physicians, infection preventionists and others, has committed to addressing antibiotic resistance by furthering education of stewardship for healthcare professionals.  Antibiotic stewardship programs and interventions help ensure that patients get the right antibiotics at the right time for the right duration. In addition to improving patient care, there is also cost saving potential. A 2012 study published in Infection Control & Hospital Epidemiology demonstrates how one health system saw significant savings from implementation of an antibiotic stewardship program that closely monitored antibiotic use.

However, everyone has a role to play in reducing antibiotic resistance. In our commitment to the Choosing Wisely® campaign, an initiative that encourages patient-provider dialogue on evidence-based medical decisions, SHEA echoes recommendations from CDC and other “Get Smart” partners:

• Don’t continue antibiotics beyond 72 hours in hospitalized patients unless the patient has clear evidence of infection.
• Avoid invasive devices (including central venous catheters, endotracheal tubes and urinary catheters) and, if required, use no longer than necessary. Device use poses a major risk for infections.
• Don’t perform urinalysis, urine culture, blood culture or C. difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to over-diagnosis and overtreatment.
• Don’t use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence.
• Don’t continue surgical prophylactic antibiotics after the patient has left the operating room.

Visit the SHEA website for more information on the appropriate use and management of antimicrobials in all healthcare settings to help improve patient care: www.shea-online.org

Source: Society for Healthcare Epidemiology of America (SHEA)