A new weapon is on the way to help in the ongoing battle against dangerous bacteria. After much study and consultation, a new antibiotic stewardship program is being created.
“Our main goal is simply to reduce the inappropriate use of antibiotics in the hospital,” says Gerald Evans, medical director of infection prevention and control. “One of the program's main elements is going to be the creation of a new audit and feedback system for every patient that's prescribed an antibiotic.”
Here's how it's going to work. An antibiotic stewardship team is now being assembled. Every day, it will find out which admitted patients were recently put on antibiotics and why. It will then give the attending care team recommendations about whether its antibiotic choice should be changed, stopped or modified.
“This system is going to be very proactive with the ultimate aim of improving patient safety and the quality of care we deliver,” says Evans.
And there are a few trends in antibiotic prescribing here that need attention, he says. One of them is the overuse of the antibiotic vancomycin for example. Many physicians prescribe it for every Staphylococcus aureus infection they deal with but evidence shows that the prevalence of the methicillin-resistant strain (MRSA), for which vancomycin is the antibiotic of first choice, is low in southeastern Ontario.
“If you have a S. aureus infection in the U.S. the likelihood that you are harbouring a MRSA is high, at about 50 to 60 per cent. But here in Canada that number is more likely to be about 15 to 20 per cent, and here locally, even less than that,” he says.
Since vancomycin is not as effective as other antibiotics like cloxacillin against the more common methicillin-susceptible strains (MSSA), the use of vancomycin provides potentially worse clinical outcomes. Vancomycin also comes with more potentially serious side effects.
Another common antibiotic issue at our hospital is the trend towards hitting every infection with a broad range of drugs right away. It's the right thing to do when a patient is critically ill, but it may not be right if the patient is not critically ill.
“Stewardship will hopefully intervene and show people that if their patient has pneumonia or a urinary tract infection, there's an acceptable antibiotic to use, rather than letting them use all the big guns right off the bat,” he says.
Another goal of the program will be to reduce the overall amount of antibiotics we use.
“There is a general view amongst healthcare professionals and the public that antibiotics only have an upside and never a downside and we know that is false,” he says.
For example, antibiotics can trigger nasty C. difficile infections in vulnerable patients. They can also negatively interact with other drugs patients are on and can produce some damaging side effects, such as allergic reactions, renal failure and severe drops in blood counts. The overuse of antibiotics also results in dangerous bacteria developing antibiotic resistance, thereby creating new super bugs.
“Antibiotic stewardship programs are gaining importance at all levels of the healthcare system for all of these reasons,” says Evans.
Still, rolling out this kind of program will be challenging.
“We know from the experience in other centres that doctors will have some degree of reluctance about other people becoming involved in their medical decision-making, even though they will still have the final authority,” he says. “But we're putting together an affable team of experts to provide them with the latest evidence-based advice and we hope they will welcome the implementation of this new resource.”
The stewardship team will be run jointly by our infection prevention and control and pharmacy departments and will include an infectious diseases physician and a dedicated clinical pharmacist.
Evans is hopeful the program will quickly pay for itself through fewer cases of C. difficile, shorter length of stays and the use of fewer antibiotics.
This antibiotic stewardship program is set to go live at KGH on August 7.
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