Posted on December 12, 2014
Hospitals today juggle the demands of increasing regulation, changing technology requirements, more stringent reporting requirements and a rising number of quality initiatives in an already challenging economic environment. With competition for time, attention and financial resources, why does your hospital need an antimicrobial stewardship program (ASP)?
A number of trends have recently converged to make antimicrobial stewardship critically important for the health of the general U.S. population, our communities and individual hospitals:
Overprescribing of antibiotics wastes money: Worldwide monitoring shows an alarming increase in antibiotics prescriptions, often for conditions that do not warrant them. In U.S. hospitals, studies indicate that up to 50% of antibiotic prescriptions are inappropriate.1 Not only are those inappropriate prescriptions dangerous, they drive up costs for hospitals, payers and patients. In fact, overuse and inappropriate use of antibiotics costs the U.S. healthcare system between $20 billion and $35 billion each year.2 An ASP promotes proper use of antibiotics, reducing wasteful, unnecessary prescriptions and costs.
Inappropriate use of antibiotics increases resistance in infectious organisms: The improper use of antibiotics directly contributes to the rising number of strains of multidrug resistant organisms (MDROs) in communities across the country, posing a significant risk to patient health. In the U.S., two million people are infected each year with resistant strains of Staphylococcus aureus, Clostridium difficile or other organisms.
Poor prescribing practices endanger patients: Receiving a broad-spectrum antibiotic triples a patient’s subsequent risk of infection with a more resistant organism, according to the Centers for Disease Control and Prevention (CDC). ASPs catch drug-bug mismatches, reduce treatment failures, and promote the use of targeted, rather than broad spectrum antibiotics, cutting a patient’s risk of contracting a more dangerous infection later.
MDROs increase morbidity and mortality: These infections lead to more than eight million additional hospital days and are responsible for 23,000 deaths each year. According to the CDC, improved antibiotic prescription reduces rates of MDROs in hospitals and improves clinical outcomes for patients. 3
MDROs increase hospital costs: Approximately 70% of healthcare associated infections (HAIs) involve organisms resistant to at least one drug. As Medicare and other payers do not reimburse for HAIs, every hospital has a significant interest in reducing the number of MDROs present in the facility and in the broader community. ASPs can save hospitals $200,000 to $900,000 per year.1
Few new antibiotics are in development: In the last 20 years, the number of antibiotics in development has dropped sharply. Since 2008, pharmaceutical companies have introduced four new antibiotics, compared to 16 approved from 1983 to 1987—and no new classes of antibiotics to treat gram-negative bacilli have been released in more than 40 years.4 Consequently, hospitals must do everything possible to maintain the efficacy and extend the useful life of the antibiotics currently available. An antimicrobial stewardship program helps ensure that the narrowest spectrum antimicrobial known to be effective is used for each infection, reducing the development of resistant strains.
IDSA/SHEA Guidelines for Antimicrobial Stewardship Programs http://www.journals.uchicago.edu/doi/pdf/10.1086/510393
Fishman N. Antimicrobial Stewardship 2014: National and regional trends. University of Pennsylvania Perelman School of Medicine. September 30, 2014.
CDC. Get Smart for Healthcare: Know When Antibiotics Work. National Center for Emerging and Zoonotic Infectious Disease. Division of Healthcare Quality Promotion.
Spellberg B. New Antibiotic Development: Barriers and Opportunities in 2012. APUA (30):1. 2012.