Stewardship Program Helps Hospitals Reduce Antibiotic Use, Prevent Bacterial Infections

The overuse of antibiotics in hospitals can lead to the emergence of drug-resistant strains of bacteria or outbreaks of infections by bacteria, such as Clostridiodes difficile (C. difficile).

Researchers at Johns Hopkins Medicine and NORC at the University of Chicago developed a comprehensive stewardship intervention, the Safety Program for Improving Antibiotic Use, which is applicable for all types of hospitals and enables frontline clinicians to make informed and responsible decisions about prescribing antibiotics.

The overuse of antibiotics in hospitals can lead to the emergence of drug-resistant strains of bacteria or outbreaks of infections by bacteria, such as Clostridiodes difficile (C. difficile). Antibiotic stewardship programs (ASPs) were not established in all medical facilities, particularly smaller and rural hospitals, where access to experts in the use of antibiotics may not be available, according to the study.

The researchers evaluated the effectiveness of the program over the course of a year at 402 hospitals across the nation in the recent study. The team looked at overall antibiotic use and C. difficile infection rates in the hospitals during the study period.

"The Safety Program for Improving Antibiotic Use was designed to reduce the harm associated with antibiotic overuse by making stewardship part of the decision-making process for clinicians," said study lead author Pranita Tamma, MD, MHS, director of the Pediatric Antimicrobial Stewardship Program at Johns Hopkins Children's Center and associate professor of pediatrics at the Johns Hopkins University School of Medicine, in a press release. "We wanted to see how much of a difference an ASP could make in a 1-year period.”

The ASP used in the study consisted of 17 webinars, each repeated 3 times and recorded for online viewing, over a 12-month timespan from January 2018 to December 2018. The webinars focused on how to establish and maintain an ASP at a hospital, methods for improving teamwork and communication, and best practices for diagnosing and managing infections without overusing antibiotics. Further, participants in the program received additional coaching and tools to enhance their ASP activities, according to the study authors.

The 402 hospitals that completed the 1-year study program included 28 academic medical centers, 122 mid-level teaching hospitals, 167 community hospitals, and 85 critical access hospitals. Compliance with the 4 key components of antibiotic stewardship improved from 8% to 74% overall during the 12 months. Antibiotic use, which was measured by days of antibiotic therapy per 1000 patient days, decreased 30% and C. difficile infections decreased 20%.

"These results are particularly remarkable as a large proportion of the hospitals in the study were under-resourced and did not have access to infectious disease specialists," Cosgrove said in a press release. "They show that no matter their size, all hospitals can develop, establish and conduct good stewardship practices with the proper resources- and remind us of the importance of organized strategies to assist hospitals and clinicians in implementing medical care best practices."

REFERENCE

Stewardship program helps hospitals reduce antibiotic use and prevent bacterial infections. EurekAlert! https://new.eurekalert.org/pub_releases/2021-03/jhm-stf031721.php. Published March 17, 2021. Accessed March 22, 2021.