Federal Bureau of Prisons: Addressing Antimicrobial Stewardship at 2 Levels

The rise of antibiotic-resistant organisms poses a great threat to national health. In 2014, President Obama issued the Executive Order: Combating Antibiotic-Resistant Bacteria to focus executive branch agencies on addressing the various issues associated with antibiotic resistance.

In response to impending global health implications and federal policies, the Federal Bureau of Prisons (BOP) Health Services Division has undertaken several initiatives to improve antibiotic prescribing practices. Their approach, published in the Journal of the American Pharmacists Association, is a comprehensive model for other systems.

In correctional facilities, inmates are housed in close proximity, have greater incidences of chronic and infectious conditions, and are more likely to have participated in high-risk behaviors —making them especially vulnerable to multidrug resistant infections.

Researchers within the BOP investigated antimicrobial stewardship program (ASP) methods and its effects on prescribing practices. Prescribers in BOP-managed institutions wrote a total of 142,907 antibiotic prescriptions in fiscal year (FY) 2010.

That number progressively decreased to 105,832 in FY2015. The number of antibiotic prescriptions per 1000 inmates correspondingly decreased from 829 in FY2010 to 625 in FY2015. The overall number of antibiotic prescriptions as a percentage of total prescriptions decreased from 7.64% in FY2010 to 5.84% in FY2015.

Although the robust multidisciplinary ASP has likely contributed to a decrease in both the total number and the rate of antibiotic prescriptions on a per 1000 patient basis in BOP, research would be required to qualify the results. Researchers would need to identify the program's effect on antibiotic resistance, adverse event prevention, and infectious complications. Further study would also be required to identify types of effective interventions and to quantify their benefit.

Overall, several interventions have helped the BOP decrease the number of prescribed antibiotics. These include focused evaluations of all antibiotic prescriptions before dispensing, development of a closed formulary, following clinical practice guidelines (including management of HIV, tuberculosis, and methicillin-resistant Staphylococcus aureus infections), an antimicrobial stewardship group led by pharmacy, and drug utilization evaluations.

Reference

Long MJ, LaPlant BN, McCormick JC. Antimicrobial stewardship in the Federal Bureau of Prisons: Approaches from the national and local levels. JAPhA. 2016 Nov 30. doi: 10.1016/j.japh.2016.11.012.