Antimicrobial stewardship programs grow in importance
practice partner
Antimicrobial stewardship programs grow in importance
Do bugs need drugs? That’ s the name of a program of Alberta Health Services and the B. C. Centre for Disease Control. The question has been a hot button in Canadian health care.
The Choosing Wisely Canada( CWC) campaign notes that roughly one in four people who take antibiotics report side effects, ranging from mild( e. g., rash, dizziness, stomach problems) to, in rare cases, severe allergic reactions. Overuse of antibiotics also encourages the growth of bacteria that can’ t be controlled easily with drugs.
That practice increases our vulnerability to antibiotic-resistant infections and undermines the usefulness of antibiotics for everyone, reminds CWC. The campaign states that fully half of all antibiotic prescriptions are unnecessary.
With antimicrobial resistance increasing, and the availability of new / effective antibiotic agents being limited, antimicrobial stewardship programs( ASPs) are growing in importance.
An article in Canada Communicable Disease Report( CCDR) highlighted the alignment between the principles of CWC and those of antimicrobial stewardship( Volume 41 S-4).“ Both programs aim to optimize patient outcomes while minimizing unintended harms associated with antimicrobial use, with the secondary goal of reducing health-care costs without impacting quality,” declares the article.
It goes on to say that the management of infectious disease syndromes is often empiric,“ where treatment is initiated in the absence of full evidence, and on an educated clinical decision.” Sometimes, results may be pending when antimicrobial therapy is initiated. Other times, results may be negative when infection is, in fact, present.
As the CCDR article suggests,“ The wise choice of diagnostic testing – including when not to perform testing – is an important principle [ in ] the management of infectious diseases, to ensure rational and safe prescription of antimicrobial therapy.”
Several CWC recommendations from specialty societies can be a launching pad for discussions about antimicrobial use. For instance, the Canadian Geriatrics Society is against using antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present. The College of Family Physicians of Canada advises against antibiotics for upper respiratory infections that are likely viral in origin( e. g., influenza-like illness) or that are selflimiting( e. g., sinus infections of less than seven days duration).
The CCDR article said that both CWC and ASPs have“ shared levers of change … which are physician-led initiatives to change practice, avoid harm and improve stewardship of valuable health-care resources.”
Since 2013, Accreditation Canada has mandated that all acute care facilities have an ASP. A great source for resources is the website of Public Health Ontario( www. publichealthontario. ca), which highlights a range of strategies and tools to build, grow and enhance an ASP. On the home page, just search for ASP or antimicrobial stewardship program. two days later. After talking it over with her daughter, a nurse, she was worried and requested a test. The results showed questionable cirrhosis of the liver.“ Now what do I do with that?” says Dr. Quinn.“ This lady doesn’ t have cirrhosis of the liver. There’ s no reason she would. More than likely she has fatty infiltration of the liver. But the only way to prove or disprove cirrhosis is by doing a liver biopsy. So now we have this hovering over us.” Dr. Quinn wonders if the issue is even worth further investigation. Still, the patient’ s anxiety is already raised.“ I feel that if I had spent a little more time with her before, this wouldn’ t have happened.” In the meantime, her abdominal pain has gone away. The downside of unnecessary tests, treatments and procedures isn’ t just the costs or the possible physical harm, but the agonizing.“ That’ s what we tend to minimize,” says Dr. Quinn.“ I’ ve seen people go out of their minds with worry. There’ s a real burden of illness associated with that too.” MD
Issue 2, 2016 Dialogue 37