one day render ineffective . We need to adopt aggressive strategies that keep the germs away and infections from occurring in the first place . Stop believing that antibiotic resistance is a problem “ over there ” in someone else ’ s hospital , state , or country — and not in our own backyard . Antibiotic resistance has been found in every U . S . state and in every country across the globe . There is no safe place from antibiotic resistance , but everyone can take action against it . Take action where you can , from handwashing to improving antibiotic use .”
In a whitepaper by Morris , et al . published in October 2019 , Research Needs in Antibiotic Stewardship , the Society for Healthcare Epidemiology of America ( SHEA ) emphasized that overuse of antibiotics in healthcare contributes to the development of antibiotic-resistant bacteria , resulting in 2 million infections and 100,000 deaths in the U . S . each year , but research is lacking to inform antibiotic stewardship programs aimed at reining in unnecessary use of these powerful drugs .
Andrew Morris , MD , medical director of the Sinai Health System-University Health Network Antimicrobial Stewardship Program in Toronto , and lead author of the whitepaper , Research Needs in Antibiotic Stewardship , says antibiotic stewardship research is in its infancy , and research funding is needed to move practice forward .
“ For most infections , we don ’ t know the optimal drug , dose , or treatment duration . For many , we don ’ t even know if they require antibiotic treatment ,” Morris says .
As Morris , et al . ( 2019 ) observe , “ Antibiotic stewardship is the effort to improve appropriate antibiotic use , at the correct dose , by the proper route of administration , for a sufficient ( but not excessive ) duration , and only when benefits outweigh potential risks ; however , defining ‘ appropriate antibiotic use ’ can be challenging without supportive data from well-designed studies . Early attempts at assessing appropriateness have used concordance with guidelines to help adjudicate prescribing behavior . Yet this approach is flawed ; national guidelines do not always prioritize treatment approaches , frequently exclude clinically relevant populations ( e . g ., immunocompromised patients , older adults , etc .), and generally fail to address other aspects of infection management , such as the role of source control . The need for up-to-date , evidence-informed guidance based on the principles of antibiotic stewardship that provides management recommendations informed by relevant patient characteristics and priorities is clear .”
The authors acknowledge that antibiotic stewardship programs have gained momentum in hospitals as a powerful tool to address inappropriate antibiotic use , but that the optimal use and full value of these programs has not yet been explored .
To address these gaps , the authors highlight four broad categories where gaps exist :
1 . A scientifically rigorous evidence base to define optimal antibiotic prescribing practices , which adequately inform stewardship interventions across a variety of patient populations and settings ;
2 . Effective stewardship approaches to recognize effective interventions , knowledge of how these interventions can be adapted for implementation both locally and across diverse settings , and an understanding of how interventions can be sustained once implemented ; 3 . Standardized processes and outcome metrics ; 4 . Advanced study designs with appropriate analytic methods , accompanied by infrastructure to support data collection and sharing .
The whitepaper outlines specific areas where additional clinical evidence is needed to define optimal antibiotic use , including diagnosing and treating pneumonia , urinary tract infections , skin and soft tissue infections , diabetic foot infections , intra-abdominal infections , and prevention of bacterial infections .
In their whitepaper , Morris , et al . ( 2019 ) outline more specifically these high-value targets for antibiotic stewardship research .
Regarding clinical evidence to define optimal antibiotic use , Morris , et al . ( 2019 ) suggest that clinicians :
• Evaluate optimal diagnosis and antibiotic management ( dose , route , duration ) of pneumonia , urinary tract infections , skin and soft tissue infections ,
AMR : Actions for Healthcare Providers
Prevent infections and the spread of pathogens
● Follow infection prevention and control recommendations , including screening atrisk patients when indicated .
● Ask patients if they recently received care in another facility or traveled to another country ( germs can be spread easily across borders ).
● Ensure your patients receive recommended vaccines .
● Alert receiving facilities when transferring patients who are colonized or infected with antibiotic-resistant pathogens .
● Educate patients on ways to prevent spread .
● Stay informed of current outbreaks .
Improve Antibiotic Prescribing
● Follow clinical and treatment guidelines . Support CDC ’ s Core Elements of Antibiotic Stewardship to ensure appropriate antibiotic use .
● Consider fungal infections for patients with respiratory infections that do not respond to antibiotics .
● Watch for signs and symptoms of sepsis . If you suspect sepsis , start antibiotics as soon as possible and reassess antibiotic therapy .
● Perform appropriate diagnostic tests to guide antibiotic therapy , including correct drug , dose , and duration .
Be alert and take action
● Be aware of infections and resistance patterns in your facility and community .
● Ensure you are notified by the lab immediately when antibiotic-resistant germs are identified in your patients .
● Inform patients and families if they have an antibiotic- resistant infection , as well as sexual partners when appropriate ( e . g ., gonorrhea ).
● Know when to report cases and submit resistant isolates to the health department to help identify unusual resistance or treatment failures .
Source : CDC