Becker's Clinical Quality & Infection Control

43 ANTIBIOTIC RESISTANCE AND STEWARDSHIP NQF, CDC Release Practical Antibiotic Stewardship Playbook: 6 Things to Know By Heather Punke T he National Quality Forum, the CDC and Nashville, Tenn.-based Hospital Corporation of America led a team of experts to create a guide for hospitals of all sizes on how to implement an antibi- otic stewardship program, and the guide, "Antibiotic Stewardship in Acute Care: A Practical Playbook" was released in May. e following are six things to know about antibiotic resistance and the newly released playbook. 1. The growing issue. e consequenc- es of antibiotic overuse and misuse have turned into a "very important and serious public health problem in the United States," Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs within the CDC, said during a press briefing webinar. In fact, per CDC data, drug-resistant bacteria cause 2 million illnesses and 23,000 deaths each year. 2. The hospital size problem. e CDC recommended in 2014 that all acute care hospitals in the U.S. implement an antibiotic stewardship program and also released the "Core Elements of Hospital Antibiotic Stewardship Programs," which outlines seven elements essential to a suc- cessful program. However, data from a 2015 survey found that less than 40 percent of responding acute care hospitals had actually implemented all seven elements, and that percentage was even lower for small hospi- tals, experts explained during the briefing. 3. How the playbook helps. e play- book pulls real-world experience from more than 40 experts from around the country to provide advice on how to implement the seven core elements in any hospital, regard- less of size. e playbook breaks down the CDC's seven core elements and provides a variety of implementation examples, ranging from basic to advanced. It also presents potential barriers to implementing each element, as well as suggested solutions, Edward Septimus, MD, medical director of infection prevention and epidemiology at HCA, explained during the briefing. 4. A practical resource. According to Sara Cosgrove, MD, director of Bal- timore-based Johns Hopkins Hospital's antimicrobial stewardship program, the playbook is "probably the most practical document on stewardship out there," as it puts best practices and implementation advice all in one convenient location, elim- inating the need for stewardship leaders to scrounge the internet for multiple sources. 5. CMS, Joint Commission pres- sures. Hospitals may soon have more reason to implement antibiotic stewardship programs, beyond the fact that they can help curb bacterial resistance and save lives — per Dr. Cosgrove, CMS is working on a dra to make antibiotic stewardship a condition of participation, and the Joint Commission is developing a standard requiring antimi- crobial stewardship in various care settings. 6. Future resources. e playbook is only applicable to acute care hospitals at this time, but antibiotic stewardship is an issue across the care continuum, including in nursing homes and outpatient care clinics. According to Dr. Srinivansan, putting to- gether a playbook for nursing homes would be difficult at this point, as the experience there on how best to implement a program is "limited." However, he said there is "defi- nitely interest in continuing to build out this work in other settings." n Study: Antibiotic Stewardship Programs Linked to Lower Antibiotic Use, Fewer Infections By Mackenzie Bean H ospital antimicrobial stewardship programs may lower the use of antibiotics by almost 20 percent and are linked to a drop in infection rates, a new study suggests. Researchers at the Warren Alpert Medical School of Brown University in Providence, R.I., and the Dana-Farber Cancer Institute in Boston performed a meta-analysis of 26 studies to compare antibiotic use and clinical out- comes before and after ASP implementation. After ASP implementation, hospital antimicrobial con- sumption across all study sites decreased by 19.1 percent and antibiotic costs dropped by 33.9 percent. While general medical wards saw a modest decrease of 12.1 percent in antimicrobial use, intensive care units posted a 39.5 percent drop in antimicrobial use. Regardless of variability in ASP implementation between hospitals, stewardship efforts resulted in lower antibiot- ic use, drug expenditures, infection rates and length of hospitalization. Researchers say future studies need to focus on the sustainability of these outcomes and evaluate the poten- tial beneficial long-term effects of ASPs in mortality and infection rates. n

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