“Superbugs” are becoming increasingly common, causing alarm, illness and even loss of life as new bacteria emerge that prove resistant to medications.
With such incidents on the rise, Regional One Health wants to be part of the solution. An Antibiotic Stewardship Committee works around the clock to promote responsible antibiotic use under the leadership of experts like clinical pharmacy specialist Maegan Rogers, PharmD, BCPS, CDE and infectious disease physicians Sara Cross, MD sand Christian Jan Fuchs, MD.
The goal is to encourage providers to use the narrowest spectrum drug possible for the shortest necessary duration. “Using antibiotics that are too broad for too long can expose patients to medications they don’t need and put them at risk for side effects and developing resistance down the line,” Rogers said. “We want to preserve the medications we have, which means preventing resistance in patients and preventing superbugs that don’t respond to existing medications.”
“We focus on the broader spectrum, potent antibiotics that treat multidrug-resistant organisms,” Dr. Cross added, noting those medications should only be used in specific situations, like when a positive culture shows they are needed or a patient becomes septic.
“We need to make sure these powerful antibiotics aren’t overused for simple infections so they remain effective for the very serious situations where they are needed.”
Several factors have contributed to antibiotic resistance, which occurs when bacteria adapt to the medicines used to fight them, rendering the medicines ineffective.
Improper prescription of antibiotics is part of the problem. In the past, doctors used the “miracle drugs” too liberally, opening the door to more bacteria becoming resistant.
Antibiotics shouldn’t be prescribed for viruses, which don’t respond to them; or mild conditions like a common cold that are generally safe to overcome without medicine. Doctors may also use antibiotics that are too broad for the condition they’re targeting: “You don’t need a broad-spectrum antibiotic meant for a pneumonia if someone has a urinary tract infection,” Rogers explained.
Patients also play a role. Failure to finish a full course of antibiotics can cause remaining bacteria to develop resistance.
Finally, pharmaceutical companies compound the problem by failing to invest in new antibiotics. “It isn’t a moneymaker,” Rogers said. “If you create a new statin, patients are on it for the rest of their lives, so you’ve created a longtime customer. Patients only use antibiotics for a week or so. It isn’t a great return on the investment, so drug makers don’t put the time or money into it.”
It has created an environment that is welcoming to superbugs, and in 2016, federal regulators asked health care systems to adopt formal antimicrobial stewardship programs.
Regional One Health had a strong position to start from: “We had already been doing the basics for a number of years, looking at the percentage of resistance to different antibiotics and defining protocol to discontinue antibiotic use as soon as medically appropriate,” Rogers explained. “The committee formalized that work.”
The group includes physicians from various specialties, pharmacists, IT, the microbiology lab and more. They gather data to see which drugs are used most and where they can improve.
“If we see one antibiotic is being used a lot, we take a closer look to make sure it’s being used right,” Dr. Cross said. “Our pharmacists do a great job educating on the spot during rounds, and they’ve made doctors more aware of the problem.”
The committee submits data to the National Health and Safety Network so Regional One Health usage patterns can be compared to similar systems. “We were doing a good job at our baseline, and our numbers continue to be good. We stay below the national benchmark,” Rogers said.
“We’ve specifically decreased the usage of the hospital-acquired antibiotics – we aren’t using as many of the big-gun, broad spectrum medications,” Dr. Cross said.
They’ve achieved that through initiatives like a patient record system that captures any time a provider prescribes an antibiotic, triggering a review by the pharmacy to confirm the dosage and drug are appropriate; and giving all antibiotics an automatic seven-day stop date that can only be overridden after provider review.
Rogers said they look forward to continuing their work.
“We can help prevent patients from building up a resistance and avoid side effects, and we can prevent superbugs and make sure we have the appropriate medication to treat patients,” she said. “It just requires education and communication.”