November 14 is the kickoff for the second annual "Get Smart About Antibiotics Week," co-sponsored by the Centers for Disease Control and Prevention (CDC).
There's no question that patients, physicians and hospital leaders need to become more informed...fast.
Here are some of the shocking findings from a recent World Health Organization survey:
• 64% of those surveyed thought that antibiotics help combat colds and flu. (They don't.)
• 32% of the respondents felt that it was fine to quit taking antibiotics mid-course if they suddenly felt better. (It isn't.)
Because patients often lack an understanding of the disease process, they sometimes badger their physicians for antibiotics that simply won't work. They need to understand that:
• The average duration of a cough is 18 days, and in most cases an antibiotic won't speed the recovery period.
• 90% to 98% of pediatric sinus infections are viral and won't respond to antibiotic treatment.
• Every time patients take an antibiotic for cold or flu, they increase the risk that they (or their family and neighbors) will join the ranks of the estimated two-million people in the U.S. who experience an antibiotic-resistant infection each year (where 23,000 cases are fatal).
Physicians and hospital leaders also need a lot more information about antibiotic best practices. Some are aware that their facilities are getting hit with readmission penalties due to antibiotic-resistant infections. But few understand that we're facing the largest public health crisis of this century.
Earlier this year, the first case of a colistin-resistant E. coli strain was reported in the U.S. It's been described as the "last puzzle piece" needed to set the stage for superbugs that would be untreatable by any known antibiotics.
In the sobering Review on Antimicrobial Resistance, former Goldman Sachs chairman Jim O'Neill and other researchers concluded that by 2050 antibiotic resistance will kill more people than cancer – and will account for six times more deaths than diabetes.
Yet the pharmaceutical industry has been reluctant to invest in antibiotic development because of research costs and the reality that medications for chronic diseases have a higher profit margin. In fact, there have been no new registered classes of antibiotics brought to market since 1984.
The CDC has outlined the core elements for a successful antibiotic stewardship program, yet only 39% of U.S. hospitals – and just 25% of those with fewer than 50 beds – have met all seven criteria. Starting next year, the Centers for Medicare & Medicaid Services (CMS) has made it mandatory for hospitals to implement antibiotic stewardship programs (ASPs) in order to continue receiving Medicare reimbursement. But they're likely to be programs with limited benefits – unless hospital leaders pay close attention to the following:
Current status of antibiotic stewardship efforts – Is our organization experiencing an increase in the number of Clostridium difficile, carbapenem-resistant enterobacteriaceae (CRE) and methicillin-resistant Staphylococcus aureus (MRSA) infections?
Legal exposure – Are we facing litigation in connection with antibiotic-resistant infections?
Physician education – Are physicians aware of the attendant risks of broad-spectrum antibiotics? Do we have an internal team tasked with changing organization-wide prescribing habits and educating doctors about the human microbiome?
C-suite/pharmacy coordination – Do hospital leaders stay informed on whether pharmacy antibiotic volumes and costs are decreasing? And has the antibiotic stewardship lead given C-suite leaders an up-to-date antibiogram (a local assessment of how microorganisms are responding to antimicrobial drugs)?
Long-term care sector – Does your transition of care team work with regional long-term care facilities toward a coordinated antibiotic stewardship program creating mutual value for patients? (Beginning next year, CMS will require long-term care facilities to have ASPs.)
Use of "silver bullet" antibiotics – How often does our health system need to use last-resort antibiotics like colistin?
Learning from other organizations – Has our hospital met with leaders from facilities that are already achieving outstanding results in their ASP programs?
Investing in rapid diagnostic technology – Are we allowing our physicians to practice "aggressive diagnostics and conservative therapeutics" by quickly determining whether an infection is bacterial or viral?
Monitoring antibiotic-related hospital readmissions – What steps are we taking to reduce readmissions due to C. difficile, which are now about 20% nationwide?
Raising trustee awareness – Most hospital boards include local business leaders who need to understand how the overprescribing of antibiotics can adversely affect community health.
Strategy for the future – Do we have a plan in place to ensure the long-term effectiveness of current antibiotics?
The first mass production of antibiotics was to support the Allied invasion of Normandy on D-Day. Antibiotics have saved countless lives since then, but their efficacy is waning. That's why "getting smart about antibiotics" is more than an educational exercise. It should be a national priority.
Dr. James M. Keegan, M.D., is an infectious disease specialist who directs the Antibiotic Stewardship service line at PYA (Pershing Yoakley & Associates), a healthcare consulting firm serving clients in all 50 states.
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