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THE CHALLENGE OF ANTIBIOTIC STEWARDSHIP Antibiotic Stewardship Educational Media

CLICK HERE to access

and / or download the

CDC’s Guideline for the Management of MDROs in Healthcare Settings

 

Antibiotics and similar drugs, together called antimicrobial agents, have been used for the last 70 years to treat patients who have infectious diseases.

 

Since the 1940s, these drugs have greatly reduced illness and death from infectious diseases. Antibiotic use has been beneficial and, when prescribed and taken correctly, their value in patient care is enormous. However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective.

 

Many fungi, viruses, and parasites have done the same. Some microorganisms may develop resistance to a single antimicrobial agent (or related class of agent), while others develop resistance to several antimicrobial agents or classes. These organisms are often referred to as multi drug-resistant or MDR strains. In some cases, the microorganisms have become so resistant that no available antibiotics are effective against them.

 

Antimicrobial drug resistance occurs everywhere in the world and is not limited to industrialized nations. Hospitals and other healthcare settings are battling drug-resistant organisms that spread inside these institutions.

 

Drug-resistant infections also spread in the community at large. Examples include drug-resistant pneumonias, sexually transmitted diseases (STDs), and skin and soft tissue infections.

 

People infected with drug-resistant organisms are more likely to have longer and more expensive hospital stays, and may be more likely to die as a result of the infection.

 

When the drug of choice for treating their infection doesn’t work, they require treatment with second- or third-choice drugs that may be less effective, more toxic, and more expensive. This means that patients with an antimicrobial-resistant infection may suffer more and pay more for treatment.

 

Reports of methicillin-resistant Staphylococcus aureus (MRSA) - a potentially dangerous type of staph bacteria that is resistant to certain antibiotics and may cause skin and other infections - in persons with no links to healthcare systems have been observed with increasing frequency in the United States and elsewhere

around the globe.

The goal of Get Smart for Healthcare is to optimize the use of antimicrobial agents in inpatient healthcare settings by focusing on strategies to help hospitals and other inpatient facilities implement interventions to improve antibiotic use.

 

Interventions and programs designed to improve antibiotic use are also referred to as antimicrobial stewardship.

 

Below, you may download important information from the CDC’s GET SMART Program.

Adult Appropriate Antibiotic Use Summary

Physicians Information Sheet (Adults)

Non-specific Upper Respiratory Tract Infection

Physicians Information Sheet (Adults)

Target Audience: Clinicians, Health Educators, Infection Control Professionals, Nurse Practitioners, Nurses, Physician Assistants, Physicians, Pharmacists.

 

CDC recommendations for promoting prudent antibiotic use in adults.

Target Audience: Clinicians, Health Educators, Infection Control Professionals, Nurse Practitioners, Nurses, Physician Assistants, Physicians, Pharmacists.

 

Principles of appropriate antibiotic use apply to the diagnosis and treatment of acute upper respiratory tract infection (common cold) in otherwise healthy adults.

BACTERIA, VIRUSES AND ANTIBIOTICS

Multi-drug resistant Klebsiella species and Escherichia coli have been isolated in hospitals throughout the United States.

 

Antibiotic-resistant Streptococcus pneumoniae infections have significantly declined, but remain a concern in some

populations.

 

Antimicrobial resistance is emerging among some fungi, particularly those fungi that cause infections in transplant patients with weakened immune systems.

 

Antimicrobial resistance has also been noted with some of the drugs used to treat human immunodeficiency virus (HIV) infections and influenza.

 

The development of antimicrobial resistance to the drugs used to treat malaria infections has been a continuing problem in many parts of the world for decades. Antimicrobial resistance has developed to a variety of other parasites that cause infection.

Acute Pharyngitis in Adults

Physicians Information Sheet (Adults)

Target Audience: Clinicians, Health Educators, Infection Control Professionals, Nurse Practitioners, Nurses, Physician Assistants, Physicians, Pharmacists.

 

Principles apply to the diagnosis and treatment of Group A
β-hemolitic streptococcal (GABHS) pharyngitis in otherwise healthy adults.

ANTIBIOTIC RESISTANT FACTS

1. Antibiotic resistance has been called one of the world’s most pressing public health problems.

 

2. The number of bacteria resistant to antibiotics has increased in the last decade. Many bacterial infections are becoming resistant to the most commonly prescribed antibiotic treatments.

 

3. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria.

 

4. Antibiotic overuse contributes to the growing problems of Clostridium difficile infection and antibiotic resistance in healthcare facilities.

 

5. Improving antibiotic use through stewardship interventions and programs improves patient outcomes, reduces antimicrobial resistance, and saves money.

 

6. Interventions to improve antibiotic use can be implemented in any healthcare setting - from the smallest to the largest.

 

7. Improving antibiotic use is a medication-safety and patient-safety issue.

 

8. Misuse of antibiotics jeopardizes the usefulness of essential drugs. Decreasing inappropriate antibiotic use is the best way to control resistance.

 

9.Children are of particular concern because they have the highest rates of antibiotic use.

 

10. Antibiotic resistance can cause significant danger and suffering for people who have common infections that once were easily treatable with antibiotics. When antibiotics fail to work, the consequences are longer-lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications. Some resistant infections can even cause death.

Acute Bacterial Rhinosinusitis

Physicians Information Sheet (Adults)

Target Audience: Clinicians, Health Educators, Infection Control Professionals, Nurse Practitioners, Nurses, Physician Assistants, Physicians, Pharmacists.

 

Principles of appropriate antibiotic use for acute rhinosinusitis apply to the diagnosis and treatment of acute maxillary and ethmoid rhinosinusitis in otherwise healthy adults.

Acute Cough Illness (Acute Bronchitis)

Physicians Information Sheet (Adults)

Target Audience: Clinicians, Health Educators, Infection Control Professionals, Nurse Practitioners, Nurses, Physician Assistants, Physicians, Pharmacists.

 

Principles of appropriate antibiotic use apply to the diagnosis and treatment of uncomplicated acute bronchitis in otherwise healthy adults.

Pharmacists Can Make the Difference

Target Audience: Clinicians, Health Educators, Infection Control Professionals, Nurse Practitioners, Nurses, Physician Assistants, Physicians, Pharmacists.

 

Principles of appropriate antibiotic use apply to the diagnosis and treatment of uncomplicated acute bronchitis in otherwise healthy adults.

by: Maryn McKenna

Winner of the 2011 Science in Society Award

Antibiotics: One of the Greatest Discoveries
of the 20th Century

Get Smart: Know When Antibiotics Work program. Date Released: 9/2/2009. Series Name: CDC Featured Podcast.

Antibiotics, When and When Not
to Use Them

This Podcast provides a brief background about antibiotics and quick tips to help prevent antibiotic resistance.

 

Created: 9/10/2008 by National Center for Immunization and Respiratory Diseases (NCIRD).

Gram-negative Infection:
One Family's Story of Loss and Hope

Antimicrobial resistance is one of the scariest prospects patients and their families now face. We should know: We lost our 27-year-old son Josh to a deadly antibiotic-resistant bacterial infection in October 2006.

 

Josh was a healthy, active skydiving instructor, attending college with passionate dreams of becoming a child psychologist. He was financing his own education by teaching other enthusiasts at a local skydiving school in Colorado.

Too Much of a Good Thing
(A Cup of Health with CDC)

During Labor Day weekend in 2006, Josh was enjoying the holiday doing what he loved best: jumping out of airplanes, something he had done more than 5,000 times before. But during a jump that weekend, he landed wrong, hitting the ground at around 55 miles an hour. The impact jackknifed his body, breaking his left femur and fracturing his skull. Amazingly, he survived these terrible injuries.

For more information, education and training on how to combat drug resistance, visit the INFECTIOUS DISEASES SOCIETY OF AMERICA website

During his almost six-week stay in the intensive care unit (ICU) that followed, Josh developed a hospital-associated infection, methicillin-resistant Staphyloccus aureus (MRSA), which the doctors were able to treat with antibiotics. Eventually, he was doing well enough to be transferred to a nearby rehabilitation facility to continue his progress.

 

Just as Josh was recuperating and on a hopeful path to a good recovery, he began to run a fever of 103 degrees. An infection caused by enterobacter aerogenes, a gram-negative bacteria, was discovered in his cerebral spinal fluid. From there, despite doctors’ efforts to treat the infection, it spread rapidly, causing unbelievable pressure around his brain. The pressure eventually pushed part of his brain into his spinal column, paralyzing him, making him a permanent quadriplegic dependent on a ventilator to breathe.

Josh died two weeks later. He was just 27.

 

The tragic, unnecessary, and lasting impact of the loss of our son continues to this day. Our family has never recovered from Josh’s death.  We feel overwhelming sadness and a great sense of loss. No holiday dinner or special family celebration ever passes without the haunting reminder of a lone chair that remains empty.

 

Since Josh’s death, we have devoted our lives to bringing attention to the serious problem of health-care acquired infections and the need for better practices, education, and solutions. We’ve learned that antibiotic-resistant gram-negative bacterial infections are a serious problem. Because they are resistant to virtually every antibiotic we have, they are one of our greatest public health threats.

Looking to the future, we hope patients and their families educate themselves on how to safely receive medical care before being admitted to a hospital to help prevent infections. Everyone who comes into contact with patients should practice appropriate hand hygiene. Lastly, we hope drug companies will invest in more research to fight these dangerous and sometimes deadly bacteria to prevent more people from suffering.

 

We look forward to a time when these infections no longer threaten to cut short the lives of the ones we love so much.

- Victoria and Armando Nahum

Co-founders, Safe Care Campaign

Victoria Nahum

678.309.9600 (Office)

678.472.9972 (Mobile)

vnahum@safecarecampaign.org

Armando Nahum

678.309.9600 (Office)

404.510.8787 (Mobile)

anahum@safecarecampaign.org

For information on how SAFE CARE CAMPAIGN  may help your hospital prevent drug resistance, contact Victoria or Armando at the addresses above.

DEFINING THE PROBLEM, EXPLORING SOLUTIONS
What are bacteria and viruses?

Bacteria are single-celled organisms usually found all over the inside and outside of our bodies, except in the blood and spinal fluid. Many bacteria are not harmful. In fact, some are actually beneficial. However, disease-causing bacteria trigger illnesses, such as strep throat and some ear infections. Viruses are even smaller than bacteria. A virus cannot survive outside the body's cells. It causes illnesses by invading healthy cells and reproducing.

What kinds of infections are caused by viruses and should not be treated with antibiotics?

Viral infections that should not be treated with antibiotics include:

 

Colds

Flu

Most coughs and bronchitis

Sore throats (except for those resulting from strep throat)

Some ear infections

What is an antibiotic?

Antibiotics, also known as antimicrobial drugs, are drugs that fight infections caused by bacteria. Alexander Fleming discovered the first antibiotic, penicillin, in 1927. After the first use of antibiotics in the 1940s, they transformed medical care and dramatically reduced illness and death from infectious diseases.

 

The term "antibiotic" originally referred to a natural compound produced by a fungus or another microorganism that kills bacteria which cause disease in humans or animals. Some antibiotics may be synthetic compounds (not produced by microorganisms) that can also kill or inhibit the growth of microbes. Technically, the term "antimicrobial agent" refers to both natural and synthetic compounds; however, many people use the word "antibiotic" to refer to both. Although antibiotics have many beneficial effects, their use has contributed to the problem of antibiotic resistance.

QUESTIONS AND ANSWERS REGARDING THE PROBLEM OF ANTIBIOTIC RESISTANCE
Define antibiotic resistance...

Antibiotic resistance is the ability of bacteria or other microbes to resist the effects of an antibiotic. Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm.

Why should I be concerned about antibiotic resistance?

Antibiotic resistance has been called one of the world's most pressing public health problems. Almost every type of bacteria has become stronger and less responsive to antibiotic treatment when it is really needed. These antibiotic-resistant bacteria can quickly spread to family members, schoolmates, and co-workers - threatening the community with a new strain of infectious disease that is more difficult to cure and more expensive to treat. For this reason, antibiotic resistance is among CDC's top concerns.

 

Antibiotic resistance can cause significant danger and suffering for children and adults who have common infections, once easily treatable with antibiotics. Microbes can develop resistance to specific medicines. A common misconception is that a person's body becomes resistant to specific drugs. However, it is microbes, not people, that become resistant to the drugs. If a microbe is resistant to many drugs, treating the infections it causes can become difficult or even impossible.

 

Someone with an infection that is resistant to a certain medicine can pass that resistant infection to another person. In this way, a hard-to-treat illness can be spread from person to person. In some cases, the illness can lead to serious disability or even death.

Why are bacteria becoming resistant to antibiotics?

Antibiotic use promotes development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria.

 

While antibiotics should be used to treat bacterial infections, they are not effective against viral infections like the common cold, most sore throats, and the flu. Widespread use of antibiotics promotes the spread of antibiotic resistance. Smart use of antibiotics is the key to controlling the spread of resistance.

 

Antibiotics kill bacteria, not viruses.

How do bacteria become resistant to antibiotics?

Antibiotic resistance occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm. Bacteria can do this through several mechanisms. Some bacteria develop the ability to neutralize the antibiotic before it can do harm, others can rapidly pump the antibiotic out, and still others can change the antibiotic attack site so it cannot affect the function of the bacteria.

 

Antibiotics kill or inhibit the growth of susceptible bacteria. Sometimes one of the bacteria survives because it has the ability to neutralize or escape the effect of the antibiotic; that one bacterium can then multiply and replace all the bacteria that were killed off. Exposure to antibiotics therefore provides selective pressure, which makes the surviving bacteria more likely to be resistant. In addition, bacteria that were at one time susceptible to an antibiotic can acquire resistance through mutation of their genetic material or by acquiring pieces of DNA that code for the resistance properties from other bacteria. The DNA that codes for resistance can be grouped in a single easily transferable package. This means that bacteria can become resistant to many antimicrobial agents because of the transfer of one piece of DNA.

 

The Food and Drug Administration's (FDA's) Center for Veterinary Medicine (CVM) produced a nine-minute animation explaining how antimicrobial resistance both emerges and proliferates among bacteria. Over time, the use of antimicrobial drugs will result in the development of resistant strains of bacteria, complicating clinicians' efforts to select the appropriate antimicrobial for treatment.

Tips you can give your patients to prevent antibiotic-resistant infections

You should only prescribe antibiotics when they are likely to be beneficial to the patient. By visiting this website, you are taking the first step to helping reduce the risk of propagating antibiotic-resistant infections. It is important to understand that, although they are very useful drugs, antibiotics designed for bacterial infections are not useful for viral infections such as a cold, cough, or the flu. Some useful tips for your patients to remember are:

 

Talk with your healthcare provider about antibiotic resistance.

 

Ask whether an antibiotic is likely to be beneficial for your illness.

 

Ask what else you can do to feel better sooner.

 

Do not take an antibiotic for a viral infection like a cold or the flu.

 

Do not save some of your antibiotic for the next time you get sick. Discard any leftover medication once you have completed your prescribed course of treatment.

 

Take an antibiotic exactly as the healthcare provider tells you. Do not skip doses. Complete the prescribed course of treatment even if you are feeling better. If treatment stops too soon, some bacteria may survive and re-infect.

 

Do not take antibiotics prescribed for someone else. The antibiotic may not be appropriate for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.

 

If your healthcare provider determines that you do not have a bacterial infection, ask about ways to help relieve your symptoms. Do not pressure your provider to prescribe an antibiotic.

How can healthcare providers help prevent the spread of antibiotic resistance?

 Prevent the spread of antibiotic resistance by:

 

Only prescribing antibiotic therapy when likely to be beneficial to the patient.

 

Using an agent targeting the likely pathogens.

 

Prescribing the antibiotic for the appropriate dose and duration.

ANTIBIOTIC PRESCRIPTIONS: ATTITUDES, BEHAVIORS, TRENDS AND COSTS

Parent pressure makes a difference.

 

For pediatric care, a study showed that doctors prescribe antibiotics 62% of the time if they perceive parents expect them and 7% of the time if they feel parents do not expect them.

 

Antibiotics were prescribed in 68% of acute respiratory tract visits and of those, 80% were unnecessary according to CDC guidelines.

 

Clearly, this must change.

 

National Ambulatory Medical Care Survey (NAMCS) data shows that overall antibiotic prescribing dropped from 13.8 prescriptions per 100 office visits to 12.0 prescriptions per 100 office visits comparing 1997-98 to 2005-06 with a 13% reduction in overall antimicrobial prescribing.

 

According to NAMCS, the Get Smart Campaign contributed to a reduction in antimicrobials prescribed for children <5 years in ambulatory care otitis media (ear infection) visits. In 2007 47.5 antimicrobials were prescribed per 100 visits, down from 61 in 2006 and 69 in 1997.

 

Among children younger than 5 years, annual ARTI (acute respiratory tract infections) visit rates decreased by 17% from 1883 per 1000 population in 1995-96 to 1560 per 1000 population in 2005-06, primarily due to a 33% decrease in visit rates for otitis media.

 

$1.1 billion is spent annually on unnecessary adult upper respiratory infection antibiotic prescriptions.

 

The CDC’s Get Smart Program has contributed to 25% reduction in antimicrobial use per outpatient office visit for presumed viral infections (NAMCS); intervention studies show a reduction of 8 to 26% for antibiotic prescriptions.

MORE RESOURCES FOR OUTPATIENT HEALTHCARE PROVIDERS

Treatment Guidelines for Upper Respiratory Tract Infections

One page academic detailing sheets and Publications - Principles for Adult and Pediatric Appropriate Antibiotic Use

Materials to Use with Your Patients

 

Download print materials:

Brochures, one-page sheets, and posters may be copied and distributed without alteration free of charge.

 

Order materials:

Small quantities are available through CDC-INFO.

Quantities in bulk are available from the Public Health Foundation. Please allow 3-4 weeks for delivery.

 

Get Smart NJ About Antibiotic Resistance

 

NJ CAUSE has developed a user-friendly, on-line educational module aimed at promoting adherence to appropriate antibiotic prescribing guidelines for the treatment of upper respiratory infections among physicians. By participating in both activities, participants will be able to:

 

Apply national guidelines for management of adult upper respiratory infections to diagnose common respiratory infections correctly and reach correct management decisions in all of the common respiratory infections presented.

 

Describe the role of antibiotics in the management of common adult respiratory infections. Describe the specific circumstances with their associated specific diagnoses, which may lead to an indication for antibiotic therapy.

 

Apply non-antibiotic supportive care to the management of common adult respiratory infections.

 

Apply national clinical practice guidelines for the diagnosis and management of acute otitis media (AOM) and for otitis media with effusion (OME) for the diagnosis of AOM and OME in children.

 

Apply national clinical practice guidelines for the diagnosis and management of AOM and for OME for the management of AOM and OME in children.

 

Describe the role of antibiotics in the management of AOM and OME in children. Describe the specific circumstances which may lead to an indication for antibiotic therapy or to withhold antibiotic therapy.

 

Apply non-antibiotic supportive care to the management of AOM and OME in children.

 

Promoting Appropriate Management of Upper Respiratory Tract Infections

 

Promoting Appropriate Antibiotic Management of Upper Respiratory Tract Infections: Antibiotics Resistance, Treatment Guidelines and Patient Satisfaction is a free web-cast specifically designed for primary care practitioners, including physicians, physician assistants and nurse practitioners. The presentation includes information about:

 

Antibiotic resistance

 

Treatment guidelines for upper respiratory infections (URIs)

 

Strategies to improve patient satisfaction when antibiotics are requested but not necessary for the treatment of the illness; and

 

How to establish effective practice protocols that improve patient outcomes by setting reasonable expectations for URI treatment and management.

 

Free online training program (CME) - Otitis Media

 

ePROM: Enhancing Proficiency in Otitis Media is a series of six interactive, image-rich online courses to improve knowledge in understanding middle ear disease and skill in visually diagnosing middle ear effusions. The courses were developed at the Hospital of Pittsburgh/University of Pittsburgh with support from CDC. Self assessments of visual diagnostic skills are also available at this site. Site registration and CME are free. Topics include:

 

Pneumatic otoscopy: equipment and techniques

 

Otitis media with effusion (OME)

 

Acute otitis media (AOM)

 

Tympanometry and acoustic reflectometry

 

Background and epidemiology

 

Tympanocentesis

 

Improving Appropriate Antibiotic Prescribing for Acute Respiratory Infections

 

The course is a free, interactive case-based on-line learning experience that will enhance your ability to:

 

Describe four consequences of the overuse of antibiotics for acute respiratory infections

 

Apply the principles of appropriate antibiotic use for treatment of acute bronchitis, acute sinusitis, pharyngitis and acute otitis media

 

Develop practical strategies to adopt appropriate antibiotic use within your practice.

 

Antimicrobial Drug Use and Resistance in Europe

 

The course is offered through the Emerging Infectious Diseases Journal with CE credits provided by Medscape, LLC.

Upon completion of this activity, participants will be able to:

 

Identify the classes of antimicrobial drugs most commonly used in Europe.

 

Describe patterns of antimicrobial drug use across regions in Europe.

 

Identify the most widely used antimicrobial drugs by country in Europe.

 

List European countries that show the highest antimicrobial drug resistance proportions.

 

Describe the association between antimicrobial drug use and the emergence of resistance.

 

Acute respiratory tract infections: When are antibiotics indicated?

 

The article is available from the Journal of the American Academy of Physician Assistants. In this second article of a series on antibiotic resistance, the authors discuss common respiratory infectious processes. The Get Smart campaign is described.

 

The articles, Acute Respiratory Infections and Antimicrobial Resistance and Is Your Patient Taking the Right Antimicrobial?, are available from the American Journal of Nursing.

 

Antimicrobial resistance: many nurses are aware of the risk but may not know that inappropriate management of acute respiratory infection contributes to it significantly. For example, more than half of antibiotics prescribed for respiratory infections are unwarranted because viruses are the cause. It is important that nurses understand antimicrobial resistance and learn how to help patients, family members, and friends manage acute respiratory infections appropriately.

 

The author describes the all-too-common phenomenon of inappropriate antimicrobial prescribing and the role it played in her sister's illness and death. The author details the ways in which bacteria become resistant to antimicrobials, discusses the prevalence and costs of health care-associated infections resulting from antimicrobial resistance, and provides practical tips on using culture-and-sensitivity reports to ensure that patients are receiving the appropriate antimicrobial treatments.

In the end, best outcomes and healthier patients are the right and noble reasons we must strive for responsible antibiotic stewardship.

The Centers for Disease Control and Prevention has launched Get Smart for Healthcare, a new campaign focused on improving antimicrobial use in inpatient healthcare settings such as acute-care facilities, and long-term care through the implementation of antimicrobial (or antibiotic) stewardship programs.

 

These antimicrobial (or antibiotic) stewardship programs are interventions designed to ensure that hospitalized patients receive the right antibiotic, at the right dose, at the right time, and for the right duration.

 

Antimicrobial stewardship interventions have been proven to improve individual patient outcomes, reduce the overall burden of antibiotic resistance, and save healthcare dollars. Implementation of an antimicrobial stewardship program in a healthcare facility – regardless of inpatient setting – will help ensure that hospitalized patients receive the right antibiotic, at the right dose, at the right time, and for the right duration.

 

As a result, there is reduced mortality, reduced risks of Clostridium difficile-associated diarrhea, shorter hospital stays, reduced overall antimicrobial resistance within the facility, and cost savings. Despite all of these benefits, antimicrobial stewardship programs and interventions are far from the norm in U.S. hospitals today.

 

If everyone - healthcare providers, hospital administrators, policy makers, and patients - work together to employ effective prevention strategies and invest in antimicrobial stewardship programs, we can more effectively combat antibiotic resistance and ultimately save lives.