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Column: Protecting the Antibiotic Arsenal

Since the discovery of penicillin by Alexander Fleming in 1928, antibiotics have served an essential role in helping the body’s immune system fight infections caused by bacteria. They are prescribed to treat myriad illnesses like pneumonia, strep throat, and urinary tract infections. Sometimes, however, antibiotics are prescribed for illnesses they cannot treat — those caused by viruses — like colds and flu, or they are prescribed too often. This misuse has given rise to drug-resistant pathogens and compromised the efficacy of our limited antibiotic options.

The U.S. Centers for Disease Control and Prevention (CDC) recently highlighted the dire consequences of antibiotic misuse and overuse in a report about the ever-increasing problem of “nightmare superbugs.” Known by an alphabet soup of letters like CRE, MRSA and VRE, these germs are becoming increasingly resistant to many if not all classes of antibiotics and are creating healthcare headaches in hospitals and nursing homes worldwide. For patients, this can mean extended hospital stays, longer lasting illnesses, even more medicines with negative side-effects, or in extreme cases, death. Now, the CDC is urging hospitals, healthcare providers, and patients to act immediately to protect our antibiotic arsenal before it’s too late.

At Inova Alexandria Hospital, I am proud to say, we are part of the solution to this global patient safety concern. In 2010, we developed an Antimicrobial Stewardship Program to optimize our use of antibiotics and provide better quality care for our patients. With a multidisciplinary team of infectious disease physicians, critical care intensivists, pharmacists, microbiologists, nurses, and clinical specialists, we created a new care model that has achieved successful results.

The hallmark of the model includes daily rounds on all patients undergoing antimicrobial therapy (antibiotics and anti-fungals) in our Intensive Care Units, as well as those on high risk or extended antibiotics in all inpatient units. In consultation with the patient’s attending physician, the team follows these patients throughout their hospital stay, closely monitoring their medications, therapies, and lab results. They ensure that every patient prescribed an antibiotic actually needs such therapy and that they receive the correct drug at the right dose via the right route for the right amount of time.

To effect change, team members educated staff about the need for judicious use of antibiotics and introduced best practices in antimicrobial stewardship, which sometimes ran contrary to traditional patterns of therapy. With help from the hospital’s physician leaders, the team overcame these conflicts and improved patient safety in the process. In the first full year of our Antimicrobial Stewardship Program, we significantly decreased the number of days ICU patients received antibiotics, as well as associated hospital costs; we also saw a decrease in patients’ hospital stays and patient deaths.

Buoyed by the successful results in our ICUs, we have expanded the Antimicrobial Stewardship Program hospital-wide and will look for other opportunities throughout Inova. We are committed to making these changes to provide the best care possible for our patients of today, while preserving our antibiotic resources so we can also provide quality care for our patients of tomorrow.