APUA and Tufts Medical Center Join Massachusetts Partners in Statewide Stewardship Training Workshop on Antimicrobial Stewardship
Kenneth Lawrence, BS, PharmD
Lisa Davidson, M.D.
Shira I. Doron, M.D., MS
Tufts Medical Center, Boston, MA.
As names like MRSA, ESBL, KPC, AmpC, NDM-1 and CDI become part of the public’s vocabulary, healthcare providers are witnessing an ever increasing move towards a time when our commercially available antimicrobial agents are no longer able to treat infections caused by the most resistant bacteria—those with so-called “extreme” drug resistance (XDR) or pan-resistance.
Unlike past decades in which the approval of newer antimicrobial agents could keep pace with development of new mechanisms for antimicrobial resistance, FDA approval of new antimicrobials has decreased 56% between 1983 and 2002. The continued overuse and inappropriate use of antimicrobial agents results in a significant negative impact on the healthcare system and on society in general. However, this is due not only to the cost of treating patients who may develop infections caused by multidrug resistant organisms, but also to the costs of unintended adverse events associated with overuse of antibiotics.
To combat these issues, many healthcare systems have developed a systematic approach to monitoring prescribing of antimicrobial agents. These interventions seek to ensure that all patients are prescribed antimicrobials for an appropriate indication, while also receiving them at the proper dose and duration based on the available evidence. These programs are collectively referred to as “antimicrobial stewardship”.
Essential participants in an antimicrobial stewardship program include the following: an infectious disease physician and infectious disease pharmacist with support from the microbiology laboratory, an infection preventionist, information technology, and hospital administration.
The literature is replete with single and some multicenter studies that demonstrate the sustained benefit of antimicrobial stewardship programs. Elements of these are varied, but may include: development of institutional based clinical guidelines; the use of computer-based decision support that may assist a clinician in choosing an appropriate antimicrobial agent based on previous antimicrobial use; organ function; and the cumulative susceptibility report for the unit or hospital. Two commonly and often cited means of antimicrobial stewardship include restrictive prescriptive authority and a prospective review with clinician feedback.
Restrictive prescriptive authority limits the availability of antimicrobials through the use of a preapproval process or by use of formulary that limits the availability of specific antibiotics. Restrictive programs may also improve the selection of antimicrobials based on the route of administration, medication allergies, kidney and liver function and concurrent medications.
Prospective review and clinician feedback permits clinicians to make empirical antimicrobial choices based on patient-specific factors. However, once culture and susceptibility data are available, an infectious disease pharmacist or physician provides recommendations about appropriate antimicrobial therapy and its duration based upon the pathogen(s) causing infection.
There is a need across the spectrum of healthcare for information on antibiotic stewardship and the components of a comprehensive approach.
During August through December, the Massachusetts Department of Public Health and the Massachusetts Coalition for the Prevention of Medical Errors (www.macoalition.org), in collaboration with antibiotic stewardship experts at Tufts Medical Center, the University of Massachusetts Medical School and the Brigham and Women’s Hospital, as well as the Alliance for the Prudent Use of Antibiotics, is providing training to enhance healthcare facility knowledge and programmatic capacity in antibiotic stewardship across the Commonwealth. The program involves a guided review of the literature, a one-day conference/workshop with interactive sessions, definition of a specific project, and a follow-up webinar and survey. The objectives will be to provide didactic instruction and practical guidance toward incorporating antibiotic stewardship approaches.
The program will take place on September 14, 2011 in Shrewsbury, MA at the Hoagland Pincus Conference Center from 7:30 am until 5 pm. For updates and more event information see www.apua.org and visit the “Events” page under the “News” section.