The Centers for Disease Control and Prevention (CDC) (2018) recommends all nursing homes to promote Antibiotic Stewardship which is a set of responsibilities and pursuits intended to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.” Antibiotic Stewardship protect the residents by means of the seven core elements which are required to efficiently apply Antibiotic Stewardship Programs and select steps to advance antibiotic prescribing practices. If Antibiotic Resistance is not taken seriously, bad things can happen especially to these frail nursing home residents. This include the following: Infections like Clostridium difficile (C. difficile), Multidrug Resistant Organisms (MDROs), adverse effects from antibiotics, harmful interactions with other medications, growing medical costs, extended hospital stays and mortality (CDC, 2017; WHO, 2018). According to Thorpe et al. (2017), the projected national cost of treating patients with an Antibiotic resistant infection would be $2.2 billion annually which also justifies why the need for innovative infection prevention and treatment programs, Antibiotic Stewardship and vaccinations is a worldwide priority. Additionally, Johnston and colleagues (2019) surveyed that the average treatment charge per inpatient hospital stay for Methicillin Resistant Staphylococcus Aureus (MRSA) is about $1,700, infection with C. difficile cost about $4,600, infection with another MDROs cost about $2,300 and infection with various MDROs cost about $3,500. Also, it is estimated that in 2050, 10 million deaths will be associated with Antibiotic Resistance (O’Neill, 2016). For that reason, if nursing home residents get to be admitted in a hospital because of these unpleasant consequences from antibiotics, more healthcare amenities will be exploited thus, intensifying healthcare expenses.
In 2016, the U.S. Congress approved $160 million to the CDC to implement Antibiotic Resistance Solutions Initiative and sponsor Antibiotic Stewardship (CDC, 2017). This is vital to stabilize more research, initiate evidence-based practices, promote education sustain Antibiotic Stewardship programs. Examples are the use of prescribing guides, pocket cards, antibiograms, data gathering forms, pre-printed order sets and electronic medical record to enable chart review and communication with constant consultations with the local stakeholders, facility leaders, infectious disease experts, residents and family members can reduce antibiotic use, C. difficile incidences, enhanced practice of guideline-concordant antibiotics and sustained chosen intervention (Katz et al., 2017). The need for a multidisciplinary team in charge with Antibiotic Stewardship and Infection control is required to further better adherence and avoid antibiotic resistance. It is also important for all healthcare workers to contribute to organizations financially or supportively by giving ideas that will help better and sustain Antibiotic Stewardship initiatives (Patton, Zalon, Ludwick, Abood, & American Nurses Association, 2015). Sustaining Antibiotic Stewardship initiatives will depend on the healthcare facilities particularly nursing homes. If the chosen Antibiotic Stewardship program will be maintained, there will be an amplified adherence to guidelines, program participation, upgraded health care performance and organizational collaboration. This generates a network of reliable healthcare staff who are experts in Antibiotic Resistance and Stewardship. Furthermore, this produces empowered leaders in stimulating a program that grooms their healthcare staff for infection prevention & unnecessary antibiotic use.
References
Centers for Disease Control and Prevention. (2015). The core elements of antibiotic stewardship for nursing homes. Atlanta, GA: US Department of Health and Human Services
Centers for disease control and prevention. (2017). Antibiotic use in the United States, 2017: Progress and opportunities. Retrieved from https://www-cdc-gov.ezproxy1.lib.asu.edu/antibiotic-use/stewardship-report/pdf/stewardship-report.pdf
Johnston, K., Thorpe, K., Jacob, J., & Murphy, D. (2019). The incremental cost of infections associated with multidrug‐resistant organisms in the inpatient hospital setting—A national estimate. Health Services Research, 54(4), 782-792.
Katz, M., Gurses, A., Tamma, P., Cosgrove, S., Miller, M., & P Jump, R. (2017). Implementing antimicrobial stewardship in long-term care settings: An integrative review using a human factors approach. Clinical Infectious Diseases, 65(11), 1943-1951. doi: 10.1093/cid/cix566
O’Neill, J. (2016). Tackling drug-resistant infections globally: Final report and recommendations. Review on Antimicrobial Resistance. Retrieved from https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf
Patton, R., Zalon, M., Ludwick, R., Abood, S., & American Nurses Association. (2015). Nurses making policy : From bedside to boardroom.
Thorpe, K., Joski, P., & Johnston, K. (2018). Antibiotic-Resistant Infection Treatment Costs Have Doubled Since 2002, Now Exceeding $2 Billion Annually. Health Affairs (Project Hope), 37(4), 662-669.
World Health Organization. (2018). Antibiotic resistance.Retrieved from https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance
Antibiotic Resistance in long-term care facilities in Arizona 
What an important topic! Thank you for discussing the importance of antibiotic stewardship this week. The frail elders are at highest risk for experiencing adverse effects of antibiotic resistance. It was shocking to read the financial impact that can occur if action is not taken place. As you mentioned, $2.2 billion annually is the cost of treating patients who have fallen victim to antibiotic resistant infections. How can we change this?
Advocacy is imperative. As you mentioned, $160 million dollars was allocated to the CDC to initiate solutions to this problem. It is the work of institutions such as this that need to occur for the health and wellness of the communities in which we live. I thank you for addressing this issue and bringing attention to it.
LikeLike
Thank you for such an informative blog and posting. Having the CDC recommend antibiotic stewardship is very impactful for patient care, and positive patient outcomes. From reading your blog and having the opportunity to hear about your project, it is apparent the significant impact that antibiotic stewardship holds. The projection that in 2050 there will be 10 million deaths associated with antibiotic resistance is alarming. I agree with your assessment of needing antibiotic stewardship policies and guidelines for sustainability in patient care environments, particularly in nursing home setting. Empowering leaders is important for implemented and sustained programming. I often wonder I fit is uneducated leadership, lack of proper funding, staff turnover rates, etc. that all impart a negative impact on the implementation and sustainability of important patient care issues like that of antibiotic stewardship.
LikeLike
This is an excellent topic that I think is not discussed enough. It fascinates me because I think, as a society, we expect to receive antibiotics when going to the doctor for something. In some ways, clinicians might even feel pressured to give out antibiotics. The exorbitant amount of antibiotics that we use in agriculture is another factor that contributes to this topic. I briefly reviewed the antibiotic stewardship program you mentioned. I found it interesting that there was no mention of using probiotics. A 2013 systematic review analyzed the role of probiotics in the prevention and treatment of MRSA. There is little clinical data published about the use of probiotics in patients with MRSA infections. Most of the results and conclusions discussed in the review came from lab culture analysis or experimentation with animals. Several experimental studies demonstrated that several Lactobacillus and Bifidobacterium strains inhibited the growth of S.Aureus and MRSA clinical isolates. Administration of B.breve saved most mice from lethal systemic MRSA infection. A 2019 meta-analysis reviewed if probiotics reduce C-diff risk. They found that the administration of probiotics within 1-2 days of beginning antibiotic therapy can prevent C-diff infections. The largest barrier to implementation is that probiotics are not approved or regulated by the FDA, so insurance coverage is limited, and there is limited availability in hospitals. Probiotics can be found over the counter and can be reasonably cost-effective when compared to other medications. I think probiotics should be further evaluated and are relevant in potentially reducing the cost associated with resistant infections that you mentioned.
References
Sikorska, H. & Smoragiewicz. (2013). Role of probiotics in the prevention and treatment of methicillin-resistant Staphylococcus aureus infections. International Journal of Antimicrobial Agents 42 (6), 475-481. doi.org/10.1016/j.ijantimicag.2013.08.003
Simpson, M. & Lyon, C. (2019). PURLs: Do probiotics reduce C diff risk in hospitalized patients? The Journal of Family Practice ¬68 (6), 351-354. https://www-ncbi-nlm-nih-gov.ezproxy1.lib.asu.edu/pmc/articles/PMC6744006/pdf/JFP-68-351.pdf
LikeLike