Becker's Clinical Quality & Infection Control

17 ANTIBIOTIC RESISTANCE & STEWARDSHIP How Intermountain researchers are helping smaller hospitals cut antibiotic use By Megan Knowles R esearchers at Salt Lake City-based Intermountain Healthcare and Univer sity of Utah Health completed a study establishing how community hos- pitals with fewer than 200 beds can create antibiotic stewardship programs that aim to prevent antibiotic-resistant bacteria growth, according to a study published in Clinical Infectious Diseases. Although e Joint Commission requires hos- pitals across the U.S. to implement antibiotic stewardship programs that improve antibiotic prescribing, prior to the study, each partici- pating hospital lacked antibiotic stewardship programs due to insufficient resources. In the study, which spanned 15 months, re- searchers compared how three types of anti- biotic stewardship programs affected 15 small hospitals within Intermountain Healthcare. To determine which program was most effec- tive in reducing broad-spectrum antibiotic use, the researchers randomly assigned each hospital to one of three types of programs. e researchers found using a centralized infectious disease support program reduced overall antibiotic use and the overuse of most broad-spectrum drugs, which target a num- ber of disease-causing bacteria. Program 1 started with basic education on antibiotic stewardship programs and a 24/7 infectious disease hotline, while program 2 built on these attributes. Program 3 had the most advanced antibiotic stewardship education programs, a 24/7 infectious disease hotline, a pharmacy-based initiative in which local pharmacists reviewed antibi- otic prescriptions, a restriction of certain broad-spectrum antibiotics and a system in which infectious disease specialists reviewed selected microbiology results and discussed treatment recommendations with providers. e study found program 3 to be the most effective. Only hospitals in program 3 saw a significant reduction in antibiotic use com- pared to baseline data, reducing broad-spec- trum antibiotic use by 24 percent and total antibiotic use by 11 percent. On the other hand, the study authors found other pro- grams that did not have central support failed to see an improvement in antibiotic use. "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 lead study author Eddie Stenehjem, MD. "e 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," Dr. Stenehjem added. e researchers concluded these programs could help providers address the growing problem of "superbugs" and fight the costly and dangerous infections affecting hospitals. "e bottom line is, small hospitals cannot do it by themselves, but by sharing experts and resources within a system, they can real- ly reduce the inappropriate use of antibiot- ics," said study author Andrew Pavia, MD. n Patients in warmer climates face higher risk of drug-resistant infections By Megan Knowles R esearch from Boston Children's Hospital and the University of Toronto in Canada revealed patients who live in warmer climates may face a greater risk of acquiring a drug-resistant infection, according to a study published in Nature Climate Change. The study revealed a 10-degree Celsius increase in an area's daily minimum temperature was linked to a slight increase in resistance among several pathogens, such as those that turn into methicillin-resistant Staphylococcus aureus infections. The research stems from a large-scale data collection initiative to develop an online application to provide the locations of drug-resistant bacteria. The website allows users to enter their postal code and deter- mine which drug-resistant infections are in their community. "For a physician, they can have a better understanding of what is happening in the community rather than just in their hospital," co-senior study author John Brownstein, PhD, told Scientific American. This data-collection tool allowed the researchers to identify new patterns in drug resistance — including how climate affects drug resistance. To evaluate how different antibiotics work against bacterial infections, the research team looked at hospital records for clinical sensitivity test results, gathering data from 223 facilities in 41 states. The team then evaluated the results of 22.8 million diag- nostic tests, which represented 1.6 million bacterial strains. The study targeted three of the most common drug-re- sistant strains: Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus. The 10-degree C increase in temperature was linked to increases in antibiotic resis- tance of 4 percent, 2 percent and 3 percent for E. coli, K. pneumoniae and S. aureus, respectively. The researchers also found a similarly significant effect after controlling for antibiotic prescription rate, population density and laboratory standards. "Places in the South tend to show more resistance than places in the North, and a good chunk of that variability can be explained by temperature," Dr. Brownstein said. n

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