Why Is there a Need for Antimicrobial Stewardships?
Antibiotics have been used for millennia to treat infections. Initially, various molds and plant extracts were used by different civilizations. Still, until the 20th century, bacterial infections such as pneumonia and diarrhea were the number one cause of death.
In 1909, German physician Paul Ehrlich became the first person to create a chemical that could kill select bacteria. This drug became the first modern antibiotic.
Antibiotics, and other antimicrobial drugs, have been fighting infections and saving lives ever since.
But then, something unexpected began occurring. The more antibiotics and other antimicrobial medications were being used on patients, the microorganisms such as bacteria, viruses, fungi, and some parasites began to mutate and develop the ability to stop the antimicrobial drugs from being effective. This became known as antimicrobial resistance.
At first, this was not much of a problem because, as antimicrobial resistance developed, a new drug would become available to take its place.
The bad news is that during the past thirty years, while antimicrobial resistance has continued to increase, antimicrobial drug development is slowing. In fact, only 10 new antibiotics have been approved since 1998, with only two of those actually having new targets of action. The reasons for this are simple: drug development is risky and expensive, and drugs that treat infections are not as profitable as those that treat chronic disease.
This means our options for treating increasingly resistant infections are becoming more and more limited. In fact, in hospitals, resistance to antibiotics and antifungals now pose the greatest concern, with tens of thousands of Americans dying from infections caused by antibiotic-resistant pathogens each year.
How Can an Antimicrobial Stewardship Help?
This is why antimicrobial stewardship is so important, now, more than ever before. It is the best way to optimize the use of antimicrobials to prevent the development of resistance, and improve patient outcomes.
While science is working to develop new antimicrobial drugs, doctors and other healthcare practitioners must conserve the antibiotics we have. In hospitals, antimicrobial stewardship teams are charged with the important initiative of developing a set of coordinated strategies to improve the appropriate use of existing antimicrobial medications by employing the optimal selection, dosage, and duration of antimicrobial treatment that results in the best clinical outcome for the treatment or prevention of infection, with minimal toxicity to the patient, and minimal impact on subsequent resistance.
First, healthcare practitioners need to make certain each patient receives the most appropriate antibiotic with the correct dose and duration. An added benefit to this approach is that facilities usually experience cost savings because fewer doses of antibiotic are used, and less expensive antibiotics are chosen. Comprehensive programs have experienced a savings of $200,000-$900,000 annually.
The second goal of the antimicrobial stewardship team is to prevent antimicrobial overuse, misuse, and abuse. This goal needs to be attained both in hospital and outpatient settings.
The third goal is to minimize the development of resistance. At both the individual patient level and at the community level, antibiotic use changes susceptibility patterns. Patients exposed to antibiotics are at a higher risk of becoming colonized or infected by resistant organisms. One of the most common examples of this is the surge in the development of Clostridium difficile (C. Diff) diarrhea.
In an attempt to address antimicrobial resistance, California passed a state law that mandates that acute care hospitals have a program in place to monitor and evaluate the utilization of antibiotics. It also mandates that a quality improvement committee be responsible for the oversight of the judicious use of antimicrobial medications. Audits by the state of California are underway, with hospitals being cited for their failure to comply with this 2010 legislation.
An infectious diseases physician is the best qualified to appropriately oversee the development, implementation, and monitoring of any antimicrobial stewardship program. Unfortunately, there is a shortage of these doctors in community and rural hospitals.
TeleMed2U has developed the first ever telemedicine-based Antimicrobial Stewardship Program to help hospitals meet these clinical and statutory needs. It is fully compliant and based in the guidelines set forth by the Infectious Diseases Society of America for Components of Antimicrobial Stewardship Programs. It includes:
- Prospective audit with intervention and feedback
- Formulary restriction preauthorization requirements for specific agents
- Provision of education
- Development of guidelines and clinical pathways
- Identification of combination therapy for prevention of resistance vs. redundant antimicrobial coverage
- Identification of a process for streamlining and de-escalation of therapy
- Dose optimization
For more information about how TeleMed2U can help your facility and staff become fully compliant with California State Law, Senate Bill 739, regarding the implementation of an antimicrobial stewardship program, please call us at 855-446-TM2U (8628)