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