Intermountain Healthcare study seeks to address antibiotic overprescription nationwide

A recent study led by Intermountain Healthcare analyzed antimicrobial management programs in 20 different healthcare systems. This is a starting point to reduce usage and avoid superbugs. (Jeffrey D. Allred, Deseret News)

Estimated duration: 5-6 minutes

SALT LAKE CITY — Antibiotics are very helpful in treating infections, but overuse and overprescription can quickly reduce their effectiveness, requiring doctors to prescribe stronger antibiotics to treat the same conditions. I have.

Dr. Eddie Stenehjem, head of antibiotic management at Intermountain Healthcare, said that because Intermountain Healthcare takes responsibility for antibiotic stewardship, it has become commonplace for them to have an effective unified system. said that it is not something that the majority of health care systems have.

A recent study led by Intermountain analyzed antimicrobial management programs in 20 different healthcare systems. These programs help hospitals and systems ensure that antibiotics are being used appropriately and reduce antibiotic use to prevent the development of bacterial resistance.

Stenehjem said the purpose of the study is to raise awareness of what a successful antibiotic management program looks like and is a step towards better management across the country.

The starting point is to analyze the effectiveness of each model and find the one that best addresses each organization’s patient care while reducing the incidence of antibiotic-resistant bacteria.

Antibiotic management program

Through research, Intermountain Healthcare researchers found that antibiotic management programs vary widely.

The completed study, published in June in the journal Clinical Infectious Diseases, divides programs into four categories.

  • Collaborative work developed systematically, run by committee, and without a formal structure.
  • It has a centrally coordinated, formal structure and accountable committee. They are often organically formed as well, but are used throughout the health care system.
  • Centrally driven with a formal system with leaders, accountability, resources and goals. Here, changes in tools and technology are system-wide and require participation.
  • A collaborative, consultative network in which leaders outside the organization participate as consultants and the site receives support from the wider company.

Intermountain Healthcare most closely resembles the centrally-led model.

Stenehjem said that when stewardship practices were implemented at Intermountain Healthcare’s 39 emergency care centers in Utah, there was a 50% reduction in antibiotic use for respiratory problems.

“It shows[the impact]of a centrally-led program in collaboration and partnership with emergency medical service lines…as we are talking about the hundreds of thousands of antibiotic prescriptions that have been denied because of these practices. said Stenedjem.

Whitney Buckel, Intermountain Healthcare’s antibiotic management pharmacist manager, said he often receives questions about Intermountain’s antibiotic management program from other healthcare systems. program.

As different methods are determined to be more effective, models can be developed for more healthcare systems.

“We want to promote stewardship everywhere, and this is a way to push boundaries and improve antibiotic stewardship nationally,” Buckel said.

In her role in the stewardship program, Buckel conducts interventions for individual patients who have an infection and are prescribed antibiotics, recommending antibiotics suitable for a particular culture, no antibiotics, or more. Suggest a short period.

Buckel explains that he’s not trying to find the best system, recognizing that the ideal system for antibiotic management can vary by health system and hospital. More information about methods and more systems devoting resources to ensure that antibiotics are used appropriately could have a significant impact on antibiotic efficacy.

super bug?

As diseases evolve to fight antibiotics, antibiotic-resistant superbugs are formed that cannot be treated with current antibiotics.

Bacteria don’t spread through the air like viruses, so an antibiotic-resistant disease won’t cause another pandemic like COVID-19, but superbugs are becoming increasingly difficult to treat. It has serious consequences.

Buckel explained that the U.S. population was heavily on “Z-packs,” the standard course of azithromycin antibiotics, but Z-packs are used so often that they are now being used. People, but because bacteria have developed resistance.

She also said that some sexually transmitted infections that were previously treated with the pill now require injections because the pill no longer works.

“It’s kind of escalating,” Buckel said.

Stenehjem said the types of infections at risk that cannot be treated with drugs are urinary tract infections, pneumonia and other infections that are not highly contagious but can be very serious.

During the COVID-19 pandemic, data on the rise of multidrug-resistant bacteria have grown, and new antibiotics are not being created fast enough to match the rate of drug resistance.

“More and more patients will continue to develop infections with completely drug-resistant pathogens for which there are no antibiotics to treat,” Stenehjem said.

What’s next for research?

Buckel said that because each health care system is now required to have an antibiotic management program, many have a minimal program in place, and electronic medical records allow the health system to do something. says it has become easier. However, much remains to be done to improve programs and effectively reduce antibiotic use.

Through a network of experienced people working on this research, she said, she was able to discuss how to start an antimicrobial management program in new organizations and the positions needed by organizations just starting out.

Stenehjem said many organizations consider antibiotic administration in hospitals, but not in the healthcare system as a whole. or used in clinics, and said that including outpatient services in its stewardship program allows the program to actually influence antibiotic consumption in the community.

“It’s really going to affect the health of the population[including outpatient systems]and it’s a public health problem because of drug resistance and the emergence of superbugs,” Stenehjem said.

This study focused primarily on inpatient care, and further research may expand to antibiotic prescribing in outpatient settings, including clinics and clinics.

Research in this area will continue, but may be led by other organizations. His Pew Charitable Trusts, which supported the study, held a meeting with stewardship experts in Utah in September to specifically discuss antibiotic stewardship in outpatient settings.

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