The proliferation of antibiotic-resistant bacteria has become a tale of “superbugs” that have altered their defense mechanisms. Two million Americans are infected with antibiotic-resistant bacteria every year, and the comfortable antibiotic counter-measures that have proven so beneficial and have saved millions of lives since the 20th century, represent a depleted arsenal. Fortunately, healthcare providers are capable of assessing the enemy and organizing a common defense for defeating it.
Determine the true nature of the threat.
The belief that all infections are attributable to bacteria is a prevalent, yet misguided notion. Many people are unaware that there is a marked difference between bacterial and viral infections. In a 2014 study featured by the Washington Post, 113 patients were surveyed to determine beliefs regarding infections and antibiotics. Nearly half of the surveyed patients reported that they believed “germs are germs,” making no distinction between viruses and bacteria. More than three-fourths of respondents were willing to take a risk of using antibiotics “just in case.”
This “just in case” approach is a dangerous one, however, as it does not effectively target the beast at hand. Simply stated, bacterial infections can be treated with antibiotics, while viral infections cannot. The first U.S. Ebola patient was sent home with antibiotics and instructed to take Tylenol to treat an unknown malady; two days later he was placed in hospital isolation. According to the Infectious Disease Society of America (IDSA), more than 90% of sinus infections are viral, so prescribing antibiotics for viral sinus infections would not be an effective weapon to combat this particular problem. The patient would not only incur a needless expense for an unwarranted treatment, but would also be unnecessarily exposed to, or placed at risk for, serious adverse events with no clinical benefit.
According to a 2013 paper—Antimicrobial Resistance and Infection Control—authored by a team of infectious disease specialists: “The misuse of antibiotics also has contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health worldwide.” Overuse stems from patients needlessly requesting antibiotics, and physicians overprescribing them. Resistant bacteria are evolving, thriving and growing, as a result. Clinical approaches such as “just in case” or “let’s use a powerful broad spectrum antibiotic to treat what we don’t know” have paved the way to an increasing amount of antibiotic-resistant strains of bacteria, also known as “superbugs.”
It is therefore imperative that physicians first identify the enemy—viral or bacterial—to properly target it using the correct weapon.
Choose the best clinical weapon carefully and organize a measured defense.
“Ideally,” said PYA Consulting Principal James M. Keegan, MD, “providers and patients would benefit from an approach of aggressive diagnostics and conservative therapeutics.” Keegan, an infectious disease specialist known for designing and implementing successful antibiotic stewardship programs (ASPs) that have been shown to reduce and reverse the incidence of drug-resistant bacteria, and his esteemed team recently joined PYA. Together they offer healthcare organizations and providers ASP solutions that are fully integrated across the multi-disciplinary patient care setting. The programs are effective and sustaining. “Patients need to be informed of their diagnoses—whether viral or bacterial,” said Keegan. “If viral, a physician can then educate patients, so they understand why antibiotics will not be prescribed and why this is best for them.” Avoidance of antibiotics for common colds and viruses will improve the body’s ability to respond to antibiotics, should they be necessary in the future.
“Patients getting powerful antibiotics to treat a broad range of infections are up to three times more likely to get another infection from an even more resistant microbe,” according to Thomas Frieden, Medical Director of the Centers for Disease Control and Prevention (CDC). In the hospital setting, where there is a threat for even greater exposure, this becomes a dangerous consequence. However, even in the immediacy of an emergency situation, providers who take the time to culture and provide specific empiric medication, will improve the community’s resistance to these superbugs.
Engage allies.
Antibiotic stewardship programs aim to promote and measure the use of the appropriate agent, dose, duration, and route of administration of antimicrobial agents, in order to improve patient outcomes, while minimizing adverse events. These programs can improve the quality of patient care and patient safety, and also can reduce excessive costs attributable to inappropriate antibiotic use. The systemic overuse of antibiotics is solvable. It is a healthcare problem that requires the implementation of effective ASPs, and a shared understanding between patient and healthcare provider.
Whether healthcare providers seek to adopt an antibiotic strategy in response to the impending Centers for Medicare & Medicaid Services’ condition of participation requirement, value-based quality of care payment factors, or a broader, societal community health-based objective, it is clear that it is critical to act now. Indecision or weakly organized antibiotic plans can be perilous to overall patient care.
Providers across the healthcare continuum – mid-level providers, physicians, hospitals, long-term care facilities, clinically integrated networks, accountable care organizations, population health managers, care coordinators, and others – now find themselves on the front lines of the battle to change the collective perspective surrounding the overuse of antibiotics. And they increasingly are looking to PYA as an ally in this population health crisis. With more than 20 years of experience and a record of proven results, PYA’s comprehensive ASP team of MDs, infectious disease specialists, RNs, C-Suite CEOs, CMOs, and other executives offers comprehensive ASP solutions for providers across the U.S.
If you would like more information about antibiotic stewardship solutions for your practice or healthcare organization, contact the experts listed below with PYA’s ASP team, (800) 270-9629.
