How can small community and rural hospitals create antibiotic stewardship programs to reduce the danger of antibiotic resistance? Scientists from the Intermountain Medical Center and the University of Utah Health have a solution.
Simply put, with increasing numbers of bacteria that are resistant to antibiotics it’s nearly impossible to treat infections that used to be easily wiped out with antibiotics. Now, many bacterial infections have to be treated with harsh drugs that cause damage to both the bacteria and to the person infected. Experts estimate that up to 50 percent of prescribed antibiotics are either unnecessary or could be used more effectively.
In a new study, researchers show how small hospitals (fewer than 200 beds) can develop antibiotic stewardship programs to prevent the growth of superbugs, pathogens that are resistant to most antibiotics.
"Having an antibiotic stewardship program in place that ensures the right antibiotic is used for the right patient, at the right time, in the right dose and route, and for the right duration will help us protect the effectiveness of the antibiotics we use," explained lead author Eddie Stenehjem, MD.
The study evaluated the effectiveness of three different antibiotic stewardship programs in 15 small hospitals for 15 months. The most effective solution proved to involve incorporating both physicians specializing in infectious disease and pharmacists from a central hospital and local pharmacists. This program successfully reduced broad-spectrum antibiotic use by 25 percent and total antibiotic use by 11 percent. Central support is key, the researchers found.
Broad-spectrum antibiotics are those that target a wide range of bacterial species. Overuse of these antibiotics promotes antibiotic resistance because the drugs target harmless bacteria that live in the human microbiome in addition to the bacterial species actually causing an infection. With more bacterial species exposed to the drug, it is more likely that they will adapt to resist the drug and share that knowledge with other, more harmful bacteria.
"The challenge has been knowing how these programs can be implemented in small hospitals, where, historically, they've been absent, even though antibiotic use rates in small hospitals are very similar to large hospitals, where the programs are typically found," Stenehjem said.
"The bottom line is, small hospitals cannot do it by themselves, but by sharing experts and resources within a system, they can really reduce the inappropriate use of antibiotics," concluded Andrew Pavia, MD. "And more appropriate use of antibiotics will help address the growing problem of 'superbugs' that can cause costly and dangerous infections.”
The present study was published in the journal Clinical Infectious Diseases.