Antibiotics are very potent medicines that help fight bacterial infection by preventing them for manifesting and multiplying. They have really transformed the world of medicine, making infections that are used to be once considered deadly, now readily curable. These compounds have also contributed to the success of many other medical advancements such as transplants of sensitive organs, skin and cancer chemotherapy among others. The use of antibiotics to treat infections has been proven by experts to reduce the total death rate of patients, saving more lives and decreasing the spread of infections caused by multidrug-resistant organisms.
Antibiotic resistance and other critical needs
Just like all other medications, misuse and overuse of antibiotics can have a whole lot of effects on patients. However, the severe health impact of antibiotic resistance and the limited pipeline of new antibiotics has been combined together to make the effects of antibiotic resistance a major public health problem. Organisms tend to adapt to the antibiotics that are designed to kill them, rendering the drugs ineffective. Experts have also noted that people infected with antibiotic-resistant organisms are likely to stay longer in the hospital as a result of this infection and more severe cases may lead to death. While antibiotic resistance has been established as the dominative crisis that leads the line for the antimicrobial and antibiotic stewardship program, it is imperative to recognize the presence of other patient safety issues that ASPs address.
Clostridium difficile poses a major threat to a significant number of patients in the hospitals, and the emergence of the BI/NAPI epidemic strain of the microorganism has initiated significant increases in mortality and morbidity rates in patients. The Center for Disease Control also estimated that no fewer than 25,000 cases concerning Clostridium difficile which has led to over 14,000 deaths in hospitalized patients in the United States annually. The application of the antibiotic stewardship has also featured as one of the most effective means in battling Clostridium difficile in hospitals and many other evidences has inferred the reduction in the prevalence and adverse effects of Clostridium difficile following the implementation of the antibiotic stewardship program.
The effectiveness and advantages of ASPs
In September 2014, the White House had announced a national strategy to combat antibiotic resistant bacteria, making antibiotic resistance prevention, surveillance and control 5 steps, which further highlights the essence of this intervention in promoting the proper use of antibiotics so as to minimize the cases of resistance and provide best patient outcomes. The good news is that the Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) have come up with a strategic program to curb the crisis of antibiotics, that which are known as Antibiotic Stewardship Programs (ASPs).
This program is geared toward encouraging accountability and guiding leadership for antibiotics utilization through the healthcare institution. Since its inception, Antibiotic Stewardship Programs have proven to be highly effective in improving antibiotic use; studies have shown that these programs are capable of reducing antibiotic resistance, adverse events( including Clostridium difficile), improving overall patient outcomes and even reduce readmission. The proven success of antibiotic stewardship programs has led to increasing calls for their implementation in all hospitals.
Several theories have been postulated by the Department of Health and Human Services in the hope to improve appropriate use of antibiotics, these may cut into how hospitals are reimbursed or penalized in the future, and ASPs if well managed, can be a means of justification for hospitals. It can also assist in maintaining high-quality patient care and reduced healthcare costs through the sustained effort of dedicated resources, which is achievable through the avoidance of adverse drug events.
Stewardship programs have also proved its effectiveness in promoting the practice of antibiotics in surgical prophylaxis and its effectiveness in aiding clinicians to optimize doses in patients suffering from renal insufficiency. Several studies on these improvements have surveyed process measures, and inferred that starting patients on proper surgical prophylaxis contributes to preventing surgical site infections as well the reduction of the potential adverse effects of the condition.
ASPs have in the past years demonstrated a great success by showing a decrease in the use of antibiotics up to 20%, with significant annual savings. According to the DSA/SHEA guidelines for developing antibiotic stewardship programs, it has been observed that these programs have the ability to support itself financially from internally generated revenues. Some ASPs recorded up to 22% to 36% decreases in antimicrobial pharmacy use, which amount to almost $200,000 to $900,000 savings annually. Hospitals that also have properly implemented ASPs often use these savings to staff and manage their stewardship efforts.
It is noteworthy that the savings generated from antibiotics may not be sustainable as a fixed revenue source, but it is definitely possible to maintain a lower cost structure and also be vigilant regarding proper utilization of antibiotics.
Progressing on ASPs
The advantages of making the antibiotic stewardship program a key feature in patient safety effort brings a number of advantages including new support and energy that have to be translated into beneficial actions. The American Hospital Association and Centre for Disease Control have emphasized the urgency and need for the antibiotics stewardship program, but the various hospitals available in the healthcare must work hand in hand to make the ASP a healthy and feasible program that is maximized for effectiveness. The CDC’s strategy which is well documented in the “Core elements for Antibiotic Stewardship Programs” which highlights all 7 elements that have been certified and proven to be imperative to the success of the program. The document also discusses the need for flexibility if these elements are to be successfully incorporated in the wide array of hospitals in the United States.
Additional actions with respect to regulations have also been implicated as panacea for making ASPs a reality in most and even all hospitals. The SHEA, IDSA and pediatric infectious diseases society have reiterated the need for the antibiotics stewardship program and have called for its addition to hospital conditions of participation for the Centers for medical and Medicaid services. A step like this will most definitely have a wide impact on a general implementation and incorporation of the stewardship program.
The essence of the antibiotics stewardship program cannot be overestimated, and is highly important to provide for optimal patient outcomes and putting the serious threat posed by emerging antimicrobial-resistant pathogens in view, as well as the fact that it can take significant time for the discovery of drugs that can tackle these pathogens, ASPs are mandatory for the preservation of antimicrobials for use in the future.
The importance of Antibacterial stewardship programs is readily demonstrated by the numerous adverse effects posed by many bacteria. Its efficacy in reducing symptoms and effects of Clostridium difficile is instrumental to preserving the lives of admitted patients. The cost reduction and redirection of funds by the ASPs have also helped many hospitals in maximizing available funds. The continued emphasis by concerned medical bodies such as the American Hospital Association and Centre for disease Control for the incorporation of the concept is also very instrumental to the survival of Antibacterial stewardship programs.