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Guidance on Implementing Antibiotic Stewardship

Guidance on Implementing Antibiotic Stewardship

As part of the National Action Plan for Combating Antibiotic-Resistant Bacteria, hospitals and healthcare systems have been called upon by the White House to implement antibiotic stewardship programs by 2020. The goal of the plan is to ensure the appropriate use of antibiotics and reduce the growing emergence of resistance. A previous guideline on antibiotic stewardship was released in 2007 and focused on the development of programs rather than on specific evidence-based strategies that have been shown to be beneficial in ensuring that such programs are effective and sustainable. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) have recently published a new guideline in Clinical Infectious Diseases that emphasizes the use of various interventions depending on local resources, issues, and expertise.   The Foundation In total, IDSA and SHEA issued 28 recommendations in the new guideline. All of these recommendations stand on their own, complete with a section of literature that supports the recommendation. The guideline was based on a review of hundreds of  stewardship-focused papers that examined different strategies, “We included new studies as much as possible,” says Tamar Barlam, MD, who co-authored the update with Sara Cosgrove, MD. “For example, several recent studies show that a shorter course of antibiotics appears to be just as effective as a longer course,” she says. “A shorter but equally effective course would theoretically provide less opportunity for side effects or the emergence of resistance.” Dr. Barlam notes that the IDSA/SHEA writing committee started with a recommendation they feel should be the first step in running an antibiotic stewardship program. “Pre-authorization, prospective audit and...
Antibiotic Resistance, Surgery, & Chemotherapy

Antibiotic Resistance, Surgery, & Chemotherapy

The CDC estimates that at least 2 million people become infected by antibiotic-resistant bacteria each year, with at least 23,000 dying from these infections. “While much concern surrounds the inability to treat existing bacterial infections, clinicians must also keep in mind the ability of antibiotics to prevent infections after surgery or chemotherapy,” says Ramanan Laxminarayan, PhD, MPH. “As resistance rates rise, antibiotics become less effective, making surgery less safe and cancer treatment more difficult.” Patients rely on antibiotics to be protect them from potentially deadly infections after undergoing many common medical procedures, including chemotherapy, pacemaker implantation, cesarean sections, and many others. The declining efficacy of existing antibiotics potentially jeopardizes outcomes in patients undergoing these procedures with regard to both morbidity and mortality.   Potential Consequences For a study published in Lancet Infectious Diseases, Dr. Laxminarayan and colleagues reviewed clinical trials between 1968 and 2011 to investigate the potential consequences of greater antibiotic resistance on the 10 most common surgical procedures and immunosuppressing cancer chemotherapies that rely on antibiotic prophylaxis in the United States. The procedures included hip fracture surgery, pacemaker implantation, surgical abortion, spinal surgery, hip replacement, cesarean section delivery, prostate biopsy, appendectomy, hysterectomy, and colon surgery. Using data from a computer model, the authors estimated the additional number of infections and infection-related deaths per year in the U.S. for various scenarios. They also estimated the percentage of pathogens causing infections after these procedures that are resistant to standard prophylactic antibiotics. Results showed that between 39% and 51% of pathogens causing surgical site infections (SSIs) and 27% of pathogens causing infections after chemotherapy are resistant to standard prophylactic antibiotics....
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