Avoid Disproportionate use of Antibiotics at Small-Scale Hospitals

The researchers have completed a study identifying how small-scale hospitals with less than 150 beds can develop antibiotic stewardship programs that are used to prevent the growth of antibiotic-resistant organisms, also known as "superbugs", which are becoming more common and destructive.

During the 1.3 years of study, researchers compared the impact of three types of antibiotic stewardship programs in 15 small hospitals. They found the most effective program used infectious disease physicians and pharmacists at a central hospital working with local pharmacists to reduce broad-spectrum antibiotic use by nearly 25 percent and total antibiotic use by 11 percent.
Researchers found other programs without central support did not see an improvement in antibiotic use.

All hospitals, no matter how large or small, need antibiotic stewardship programs to help physicians use antibiotics proportionately and prevent the growth of antibiotic-opposing organisms. Till date, it's unclear how small community and rural hospitals could establish such programs to efficiently reduce antibiotic use. Antibiotic stewardship programs are now required in all U.S. hospitals regardless of their size.

Antibiotic resistance, which is initiated by the excessive use of antibiotics, signifies bacteria adapt in a way that reduces the ability of antibiotics to prevent infections. The bacteria can then turn into drug-resistant "superbugs" that can cause life-threatening infections. Antibiotics are also liable for any side effects in patients in the hospital, including Clostridium difficile, or C diff.
Experts estimate 30 to 50 percent of prescribed antibiotics could be used more effectively, or are unnecessary.

"Having an antibiotic stewardship program in place that ensures the right antibiotic is used for the right patient, at the right time, in the right dose and route, and for the right duration will help us protect the effectiveness of the antibiotics we use," said Eddie Stenehjem, MD, an infectious disease specialist with Intermountain Medical Centre and lead author of the study.

"The challenge has been knowing how these programs can be implemented in small hospitals, where, historically, they've been absent, even though antibiotic use rates in small hospitals are very similar to large hospitals, where the programs are typically found," he added.

Before the study, each of the participating hospitals lacked antibiotic stewardship programs. Each hospital was randomly assigned to one of three types of programs to observe which was most competent in reducing broad-spectrum antibiotic use:

Program 1:
Implemented basic education to physicians and staff on antibiotic stewardship programs
Provided a 24/7 infectious disease hotline staffed by infectious disease specialists

Program 2:
Provided more advanced antibiotic stewardship education
Provided a 24/7 infectious disease hotline staffed by infectious disease specialists
Implemented a pharmacy-based initiative in which local pharmacists reviewed the use of broad-spectrum antibiotics and provided recommendations for improvement to prescribers
Certain broad-spectrum antibiotics were restricted, and only local pharmacy staff could approve their use

Program 3:
Provided more advanced antibiotic stewardship education
Provided a 24/7 infectious disease hotline staffed by infectious disease specialists
Implemented a pharmacy-based initiative in which local pharmacists reviewed most antibiotic prescriptions and provided recommendations for improvement to prescribers
Certain broad-spectrum antibiotics were restricted, and only centralized infectious diseases pharmacists could approve their use

"For the first time, all of the participating hospitals had access to infectious diseases physicians via a hotline," said Dr. Stenehjem. "This allowed the patients to receive expert consultation while remaining in their community."

Only hospitals in program 3 saw a significant reduction in antibiotic use compared to baseline data. Hospitals in program 3 reduced broad-spectrum antibiotic use by 24 percent and total antibiotic use by 11 percent.

"The bottom line is, small hospitals cannot do it by themselves, but by sharing experts and resources within a system, they can really reduce the inappropriate use of antibiotics," said Andrew Pavia, MD, professor of pediatrics at the University of Utah Health. "And the more appropriate use of antibiotics will help address the growing problem of 'superbugs' that can cause costly and dangerous infections.

To Discover more and enhance your research base in Medical Microbiology visit http://medicalmicrobiology.alliedacademies.com/.

medical microbiology | medical | microbiology | biology | chemistry | antibiotics | super-bug | infection | infectious | diseases | stewardship 

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