Last month, scientists identified the first patient in the United States with an infection that is resistant to our last line of antibiotic defense, a drug called colistin.
While some media reports were informative, others escalated the hysteria which threatened to overtake the public discussion about what to do.
But antibiotic resistance isn’t a new issue. Before the patient was identified last month, the Centers for Disease Control and Prevention (CDC) had estimated that antimicrobial resistance leads to two million illnesses and 23,000 deaths annually in the US. In Europe, 25,000 people die each year from it. And microbial resistance is growing in the Middle East, Africa, and Asia.
Instead of being paralyzed by this information, we should respond with a systematic approach to make sure our work to improve patient safety also reduces harm associated with the improper use of antibiotics.
Experts have been working on solutions to antibiotic mismanagement for years. We already know what to do. Now is the time to act.
How to Minimize Unintended Consequences
One reason for growing antibiotic resistance is the lack of new antimicrobials in the research and development pipeline. But health care is also responsible for the problem.
Here’s how health care practitioners may be unwittingly contributing to antibiotic resistance:
- Giving antibiotics when a patient doesn’t need them;
- Continuing antibiotics when they are no longer necessary;
- Administering the wrong dose;
- Using broad spectrum agents when they aren’t required;
- Using the wrong antibiotic; and
- Poorly informing patients about the dangers associated with improper use of antibiotics.
The best approach to dealing with antibiotic resistance is to make sure antibiotics are contributing to the best outcomes while also minimizing unintended consequences. One way is to focus on the 5 “Ds” of antimicrobial prescribing: diagnosis, drug selection, dosage, de-escalation, and duration.
To that end, the National Quality Forum and the CDC, along with 25 stakeholders and experts (including IHI’s Dr. Don Goldmann) have developed Antibiotic Stewardship in Acute Care: A Practical Playbook.
The Playbook offers practical advice based on CDC’s Core Elements of Hospital Antibiotic Stewardship Programs:
- Leadership — Top executives must commit to dedicating necessary resources.
- Accountability — Appoint a single leader responsible for outcomes.
- Drug expertise — Select a single pharmacy leader.
- Action — Implement at least one recommended action.
- Tracking — Monitor process measures, impact on patients, antibiotic use, and resistance.
- Reporting — Teams should regularly share the data they collect.
- Education — Providers should receive regular instruction on use and resistance.
A Global Effort
As I travel around the world for my work with IHI, it’s become increasingly clear that no region of the world is immune to the consequences of this serious public health issue.
During IHI’s recent Middle East Forum in Qatar, I led a session with Dr. Jameela Alkhowaiter Al-Ajmi, Senior Consultant in Adult Infectious Diseases at the Hamad Medical Corporation, on the proper prescription, dosing, and distribution of antibiotics. Over 500 participants attended the session.
Dr. Al-Ajmi described the three-pronged approach required to minimize resistance: infection control; antibiotic utilization management; and environmental oversight (cleaning, use of germicides, etc.)
Many scientists have been warning about the increasing threat of antibiotic resistance for years. They’ve already done the work of developing practices that have been at our disposal for just as long.
Isn’t it about time that we use them?
IHI Vice President Frank Federico, RPh, is faculty for the IHI Patient Safety Executive Training Program.
You may also be interested in:
CDC/IHI Antibiotic Stewardship Drivers and Change Package
WIHI: All Hands on Deck to Reduce C. Difficile