Antibiotic Stewardship Programs Launched to Fight Back against Resistant Bacteria

Sara Afshari can recall the first day she walked through the front doors of NorthShore Hospital. “For a routine hip surgery, I thought I would be out of the hospital in a week.” Almost six months later, she has yet to leave the building. In her hospital bed, her body remains frozen, even a subtle movement shoots pain through every limb of her body. Sweat drips down her face as a rampant fever overcomes her body, trying desperately to crush the uncontrolled infection inside of her. “I can almost feel it in me” she says, “I just don’t know what else I can do to fight back.”

During her recovery from the surgery, Afshari developed a certain strain of antibiotic resistant bacteria, called MRSA, which extended her stay at the hospital indefinitely. Her physicians must resort to more powerful and expensive medications, ones that come at both a high financial and physical cost. “These second and third tier antibiotics can result in terrible side effects that are typically much harder on the patient than the actual infection,” says Dr. Masood, Immunologist at NorthShore. “In Sara’s specific case, we really didn’t have any other choice.”

Healthcare organizations around the U.S are finally responding to cases like Afshari’s as she battles for her life against resistant bacteria. A new initiative, named antibiotic stewardship, has spread across the country to ensure current and future doctors prescribe antibiotics only when necessary. In June of 2015, the Association of American Medical Colleges (AAMC) along with 150 other organizations supported a White House Forum on antibiotic stewardship, bringing together various stakeholders to ensure antibiotics are used responsibly. The conference established guidelines for fair use, as well as goals for the next five years to hold all members accountable for their efforts.

When looking at the statistics, the timing of these initiatives couldn’t be more appropriate. According to the CDC, more than 2 million people each year become infected with a strain of bacteria resistant to a variety of antibiotics in the United States alone. From this amount, over 23,000 die every year from these infections, a number that has rapidly increased by roughly 33% in the past two years as bacteria have developed resistance to the same antibiotics that revolutionized modern medicine decades ago.

Physicians are not the only contributing factor to the rise of resistant bacteria in our world. Other components include overuse of antibiotics in animal feed, consumer health products, and on certain fruits. While health organizations have started to address the over prescription issue, there has been little response from these firms in the agriculture and soap industry. Both Agribusiness Council and Proctor & Gamble declined to be interviewed in this news feature.

Inappropriate use of antibiotics has been cited as the driving cause of this new epidemic. “Physicians misuse these drugs all the time. The consequences of prescribing heavy antibiotics after a single cough or sneeze are just being realized by society.” says Dr. Gary Huffnagle, Professor of Microbiology at the University of Michigan. The numbers back Dr. Huffnagle’s argument: over half of all antibiotics prescribed were later deemed unnecessary, according to the CDC.

In the past, health organizations have tried to develop protocols to reduce over-prescription of antibiotics, however, these efforts have proven to be futile. In a recent study done by a health informatics group, over 70% of all interventions to improve antibiotic prescribing in hospitals have failed for a variety of reasons. “Our attempts were simply not good enough,” says Tanvi Meta, quality specialist at AAMC. “It takes a collective effort from everyone to solve such a massive and complex issue.”

The AAMC learned from their past mistake. This organization, comprised of all 141 medical schools and 400 major teaching hospitals, has implemented its own agenda last year to ensure all medical schools have the necessary information and resources to train future doctors in effective use of antibiotics. At Duke Medical School, first year student Armaan Safarloo has noticed changes in the curriculum highlighting this critical issue. “In almost every class, we learn about antibiotic stewardship,” Safarloo says, “We have to ensure we don’t prescribe antibiotics unnecessarily without testing first if it will be of any use.” Although the process may be painstaking, Safarloo understands why it must be this way. “I’ve seen it happen firsthand and it’s absolutely terrifying,” he says. “When a patient has a certain bug that no antibiotic can cure, the best we can do is to make sure that they are comfortable until the end.”

Michigan Medicine has responded with their own program as well, introducing appropriate use of these medications into past and new courses. “Through a combination of didactic lectures and small group discussions, we ensure consistent conversation to train these young health professionals the appropriate techniques of prescription.” says Dr. Tejal Gandhi, Medical Director of the Antibiotic Stewardship Program at the school.

In Michigan, collaboration between physicians and other health care specialists has been critical to the success of the state’s management of antibiotic resistance. Hospitals across the state have enlisted the help of infectious disease specialists, trained nurses, and pharmacists to assist physicians on making the right decision regarding antibiotic prescriptions. “We should be very proud of our new efforts,” says Dr. Eden Wells, Chief Medical Executive for the Michigan Department of Health and Human Services. Dr. Wells points to this partnership between disciplines as the driving force in reducing antimicrobial resistance throughout Michigan hospitals. “I don’t think it’s a matter of checking every single prescription. There are certain antibiotics that should be reserved, we call them “cannons” – strong antibiotics that are reserved for serious infections only. An infectious disease specialist in Michigan can flag that script and ask future questions, leading to more careful usage.” she says.

Dr. Masood still questions how this new theory would be put to practice. “When you have a patient, like Sara, who is dying and you don’t know what’s wrong, sometimes you don’t have time to check and have to throw everything in your arsenal to save your patient’s life,” she says. “It’s so difficult to think you could be holding onto the medication that would ultimately make a difference in the end.”

 

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