Primary Care
Scientists have been able to create remarkable medical innovations in the last 100 years – including antibiotics. Starting in 1928 with the discovery of penicillin by Alexander Fleming, antibiotics have changed how providers treat infections and study bacterial disease.
Antibiotics are part of a larger group of medicines called antimicrobials, which treat infections caused by bacteria, fungi, parasites, and viruses. While these medicines are often very helpful to patients, there are risks that can come with overprescribing them or using them too often.
Maryrose Laguio-Vila, MD, is an infectious disease specialist with Rochester Regional Health and serves as the Medical Director for the Antimicrobial Stewardship Program. She explains the program and how the latest research in this field is affecting healthcare.
In the medical field, stewardship applies to the mindful use of resources – especially when they are limited.
Antimicrobial stewardship focuses on how to best use antibiotics wisely for our patients. This centers around three main ideas: (1) establishing the right diagnosis for when antibiotics are needed, (2) when needed, which antibiotic is the right one to use , and (3) giving the right antibiotic for the right period of time (not too long, and not too short).
“The root of antibiotic stewardship is to provide excellence in the appropriate use of antibiotics today, so we can limit unintended antibiotic consequences and the emergence of antibiotic-resistant bacteria tomorrow,” Dr. Laguio-Vila said. “This philosophy promotes a mindful approach toward antibiotic use so we can come up with useful guidelines for all providers on how to use antibiotics safely and judiciously.”
The risks of overprescribing antibiotics can lead to serious consequences, both short and long term. This includes side effects of the drugs themselves, along with a buildup of antibiotic-resistant organisms.
Studies show that, for each day a patient uses an antibiotic, they have a 4 percent chance of experiencing an allergic reaction. This is a significant reason why providers are advised to prescribe antibiotics to patients only as long as they are needed.
For patients who are given a lot of antibiotics, this can lead to a combination of highly-resistant bacteria living in the body and the elimination of all good bacteria in certain parts of the body. For some patients, this can increase the likelihood of Clostridioides difficile (C Diff) infections in the colon.
“As resistance to antibiotics increases, this can lead to infections that are harder to treat, higher levels of morbidity and mortality, and increased healthcare costs,” Dr. Laguio-Vila said. “At Rochester General Hospital, we review approximately 12,000 charts on hospitalized patients over the course of a year. Of those charts, the antibiotic stewardship program notes that the vast majority of our providers are following the correct guidance when it comes to prescribing antibiotics. But we do intervene in 15-20 percent of cases. We find opportunities to either narrow antibiotics or shorten durations of therapy and help the providers continue to use antibiotics better.”
Creating and overseeing best practices through stewardship programs can be good not only hospital systems as a whole, but also providers and patients. These happen in several ways.
Studies show one of the top 5 reasons why people go to the emergency department is for a reaction to antibiotics. With better antibiotic stewardship, safer antibiotics can be promoted and result in fewer people admitted to the hospital with antibiotic adverse reactions.
If providers reduce the amount of time a patient is on antibiotics, studies show this can lead to less time spent in the hospital. This is especially true with patients who may be on long-term IV antibiotics.
If a provider prescribes less of an antibiotic, this is a reduced cost for patients. Since patients don’t need to pay for more medications, they save money.
When a patient is taking multiple antibiotics, they may be at increased risk for side effects from multiple drugs. Some drugs also interact with one another in ways that providers do not expect, and could cause unforeseen harm to a patient’s body. By adjusting the use of antibiotics, providers can reduce these risks.
Each hospital system has a multi-year plan for antimicrobial stewardship and combatting antibiotic resistance, laid out according to CDC guidance.
Two independent organizations, the Joint Commission and DNV, recommend every U.S. hospital should have at least one expert in managing infectious diseases or using antibiotics who can be held accountable and responsible for guidance and use of antibiotics within the hospital. This can be a provider or a pharmacist; Dr. Laguio-Vila works with two infectious disease pharmacists at Rochester Regional.
Together, this team actively reviews prescribed antibiotics, especially ones that treat a broad spectrum of bacteria or are high risk for side effects. They also advise providers on how to narrow the spectrum of antibiotics administered to a patient, shorten the duration of time patients receive them, remind them of current guidance, and advise them about any complicated antibiotic resistance that may occur. Antimicrobial stewards will also stay in contact with providers so the providers can see what kind of recommendations are made.
The stewardship team also provides lectures on the principles and current guidelines being put to use to educate residents – medical, pharmacy, podiatry and others – as well as hospitalists and advanced practice providers. All of these providers have access to a specified website with educational tips to show them how Rochester Regional’s antimicrobial stewardship team operates.
Most guidelines for providers are updated annually.
“Someday, no one will need a stewardship program because we will be able to use antibiotics perfectly,” Dr. Laguio-Vila said. “The hope for the future is also to have better diagnostic tests to that can guide providers on when to start antibiotics or when not to start them at all.”
