Multidrug resistant organisms (MDROs) infect two million Americans each year, resulting in eight million hospital days and approximately 23,000 deaths.1 These infections are challenging and expensive to treat, costing the U.S. healthcare system $20 billion to $35 billion.2 Because MDROs cause many healthcare-associated infections (HAIs), which are not reimbursed by Medicare or many other insurers, hospitals have a significant incentive to reduce the prevalence of HAIs and prevent the emergence of MDROs in their facilities. Four steps help hospitals accomplish both goals:
Use antibiotics only when needed. Nearly half of antibiotic prescriptions in U.S. hospitals are unnecessary.3 Hospitals can use procalcitonin levels as a biomarker for infection, avoiding use of unnecessary antibiotics. Hospitals can also increase the use of rapid diagnostic tests to determine whether an infection is bacterial and, if so, what type of infection, so that patients do not receive antibiotics likely to be ineffective for the specific infection.4 Polymerase chain reaction tests can now detect methicillin-resistant Staphylococcus aureus (MRSA), tuberculosis, Group B Streptococcus, Candida albicans, vancomycin-resistant enterococcus, Neisseria gonorrhoeae and more. Other molecular methods under development will enable identification of pathogens within an hour or two of sample collection.
Prescribe fewer antibiotics for shorter periods. A number of studies have shown that short courses of antibiotics work just as well as longer courses, while contributing less to the development of MDROs.5 In addition, many patients receive multiple antibiotics, often with overlapping areas of effectiveness. For instance, 23% of patients given metronidazole also had prescriptions for another agent targeting anaerobic bacteria.
Use oral instead of intravenous formulations when possible. Shifting patients to oral medications reduces the incidence of HAIs associated with catheter use and permits earlier discharge of patients.6
Institute automatic time-outs for empirically prescribed antibiotics. Stopping antibiotics after 48-72 hours without laboratory confirmation of infection causes clinicians to reevaluate the need for antibiotics and assess whether the most effective medication has been prescribed when an infection has been identified.
Together, these steps can dramatically reduce the emergence of MDROs in healthcare facilities and diminish the prevalence of HAIs as well.
1. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Atlanta GA:CDC;2013.
2. Fishman N. Antimicrobial Stewardship 2014: national and regional trends. University of Pennsylvania Perelman School of Medicine. September 30, 2014.
3. IDSA/SHEA Guidelines for Antimicrobial Stewardship Programs.
4. Bartlett JG, Spellberg B, Gilbert DN. 8 Ways to Deal with Antibiotic Resistance. Medscape Infectious Diseases. August 7, 2013.
5. Bartlett JG, Gilbert D, Spellberg B. Seven ways to preserve the miracle of antibiotics. Clinical Infectious Disease. 2013;56:1445-1450.
6. American Society of Health-System Pharmacists. A Hospital Pharmacist's Guide to Antimicrobial Stewardship Programs.