Hospital Programs to Reduce Antibiotic Resistance Working: Studies

But not enough hospitals following the guidelines, research finds

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By Robert Preidt

Thursday, October 20, 2011 HealthDay Logo

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THURSDAY, Oct. 20 (HealthDay News) -- Hospital programs to lessen the overuse of antibiotics are helping to reduce antibiotic resistance and costs, but too few hospitals have fully implemented such programs, according to new research.

Antimicrobial stewardship guidelines -- intended to prevent antibiotic resistance -- for acute care hospitals in the United States were released in 2007 by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America, but many hospitals had implemented antimicrobial stewardship programs before that.

"We believe strongly that antimicrobial stewardship is beneficial and prevents the escalation of resistance in bacterial infections, but it's nearly impossible to prove a direct cause and effect," Dr. Ruth Lynfield, chair of IDSA's Antimicrobial Resistance Work Group, said in a society news release.

"These research studies -- including the longest study to date -- found a decrease in resistance, as well as a decrease in cost with implementation of these programs. Resistant infections can be very difficult and costly to treat. Unnecessary antibiotic use can cause adverse effects as well as add costs. We hope that studies such as these will help convince other hospitals to invest in antimicrobial stewardship," Lynfield said.
In a 17-year study to be presented at the IDSA's annual meeting, researchers found that an antimicrobial stewardship program implemented in 1993 at Wesley Medical Center in Wichita, Kan., was associated with greater susceptibility of bacteria to antibiotics and a decrease in the amount spent on antibiotics.

Antibiotics now account for 9 to 14 percent of the medical center's yearly pharmacy budget, compared with 22 percent before the start of the program.

"We've definitely seen improvements, some gradual, some quite dramatic," Derick Gross, a clinical pharmacist in adult medicine at Wesley, said in the news release.

Another study to be presented at the meeting found that implementation of an antibiotic stewardship program at two University of Minnesota hospitals resulted in two-year savings of $733,000.

The net savings were $244,000 after the researchers factored in salary costs for infectious disease physicians and pharmacists working on the program.

The savings were achieved by reducing inappropriate antibiotic use and by using less-expensive antibiotics when possible. The average number of antibiotics prescribed per adult patient fell from 2.39 to 2.34 and from 2.98 to 2.37 for each child. Antibiotic doses per patient/day fell by 7 percent and antibiotic costs per patient/day decreased by $7.40.

"The patients actually benefit because we are treating infections optimally by not using antibiotics when they are not necessary and using less expensive antibiotics that do the job better and more safely than expensive ones," Dr. Susan Kline, medical director for the University of Minnesota Medical Centers Infection Control Program, Minneapolis, said in the news release. "We also have seen some trends that suggest the program has prevented emergence of antibiotic resistant bacteria."

Despite such positive results, a third study found that only about one-third of U.S. hospitals are fully compliant with the 2007 antimicrobial stewardship guidelines.

Researchers reviewed surveys completed by 270 hospitals and found that all had implemented some components of the guidelines, but 184 (68 percent) were not fully compliant. The most common reason for only partial compliance was lack of funding and personnel for the program, which was cited by 121 (44 percent) of the hospitals.

Because this research was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

SOURCE: Infectious Diseases Society of America, news release, Oct. 18, 2011

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