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Published on May 01, 2018

Antimicrobial Stewardship Curtails Antibiotic Use, Reduces C. diff, Rates

Antimicrobial Stewardship at NKCH

North Kansas City Hospital’s antimicrobial stewardship program includes these care elements:

  • Leadership commitment: Dedication of the necessary human, financial and information technology resources
  • Accountability: Appointment of a single leader responsible for program outcomes
  • Drug expertise: Appointment of a pharmacist leader responsible for working to improve antibiotic use
  • Action: Implementation of recommended actions, such as systemic evaluation of ongoing treatment need after a set period of initial treatment
  • Tracking: Monitor the antimicrobial stewardship program, which may include information on antibiotic prescribing and resistance patterns
  • Reporting: Regularly report on the antimicrobial stewardship program, which may include information on antibiotic use and resistance, to physicians, nurses and relevant staff
  • Education: Educate practitioners, staff and patients on the antimicrobial program, which may include information about resistance and optimal prescribing

North Kansas City Hospital has long led the way in helping prevent antibiotic resistance in patients, the rise of which has caught the attention of the Centers for Disease Control and Prevention, The Joint Commission and the World Health Organization.

In 2014, the CDC recommended that all acute care hospitals implement stewardship programs. The Joint Commission’s accreditation standard requiring all hospitals to have an antimicrobial stewardship program went into effect Jan. 1, 2017. The same year, the WHO reported on the rise of antibiotic resistance to dangerously high levels in all parts of the world, threatening the ability to treat common infectious diseases.

The WHO pointed to a growing list of health issues – pneumonia, tuberculosis, blood poisoning, gonorrhea and foodborne diseases – that are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.

“Years ago, there were no stop dates for antibiotics, and antibiotics would go on for weeks and weeks, said R. Beth Henry, MD, assistant medical director of epidemiology and infectious diseases at NKCH and an infectious disease specialist with Metro Infectious Disease Consultants. “Certainly we want to give appropriate antibiotics when they are indicated, but we’re also doing our very best to make sure our patients are on the right antibiotic dose for the right duration. If they do not appear to have a bacterial infection they don’t get unnecessary antibiotics.”

Appropriate Use

Dr. Henry leads the antimicrobial stewardship committee at NKCH, which began in 2014. The program promotes the appropriate use of antimicrobials to improve patient outcomes, reduce microbial resistance and decrease the spread of infections caused by multidrug-resistant organisms.

The multidisciplinary committee includes physicians, as well as NKCH staff from Infection Prevention, the Lab, Microbiology, Nursing and Pharmacy. The work involves educating individuals on the appropriate use of antibiotics, monitoring antimicrobial resistance and developing patient education materials (see box at right).

With antibiotic use as the No. 1 factor for acquiring Clostridium difficile, the team sought to bring antibiotic use down, ultimately reducing levofloxacin use by 40% and lowering the C. diff. rate in patients from 1.4 in 2015 to 0.7 in 2017 (see table below).

“Antimicrobial stewardship offers better overall care for our patients,” Dr. Henry said. “Yes, it can reduce C. diff. rates, but it also can reduce nausea and diarrhea brought on by antibiotic use.”

Good Culturing

The team developed protocols for appropriately collecting urine specimens and minimizing screening to reduce overtreatment of asymptomatic bacteriuria.

“It’s tempting to treat an abnormal urinalysis before the urine culture comes back,” Dr. Henry said. “However, a lot of urine cultures come back with mixed organisms, so the patient has been given two or three days of unnecessary antibiotics. By reducing testing, we can potentially reduce antibiotic use.”

Clostridium difficile SIR and Levofloxacin usage chart

R. Beth Henry, MD

Beth Henry, MDDr. Henry earned her medical degree from the University of Arkansas College of Medicine, Little Rock. She completed her internal medicine residency and infectious disease fellowship at the University of Missouri, Columbia.