Core elements of hospital antibiotic stewardship programs
Corporate Authors:National Center for Emerging and Zoonotic Infectious Diseases (U.S.). Division of Healthcare Quality Promotion.
Description:Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable and making other medical advances, like cancer chemotherapy and organ transplants, possible. The prompt initiation of antibiotics to treat infections has been proven to reduce morbidity and save lives, with a recent example being the rapid administration of antibiotics in the management of sepsis. However, 20–50% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. Like all medications, antibiotics have serious side effects, including adverse drug reactions and Clostridium difficile infection (CDI). Patients who are unnecessarily exposed to antibiotics are placed at risk for serious adverse events with no clinical benefit. The misuse of antibiotics has also contributed to the growing problem of antibiotic resistance, which has become one of the most serious and growing threats to public health. Unlike other medications, the potential for spread of resistant organisms means that the misuse of antibiotics can adversely impact the health of patients who are not even exposed to them. The Centers for Disease Control and Prevention (CDC) estimates more than two million people are infected with antibiotic-resistant organisms, resulting in approximately 23,000 deaths annually.
Improving the use of antibiotics is an important patient safety and public health issue as well as a national priority. The 2006 CDC guideline “Management of Multi-Drug Resistant Organisms in Healthcare Settings” stated that control of multi-drug resistant organisms in healthcare “must include attention to judicious antimicrobial use.” In 2009, CDC launched the “Get Smart for Healthcare Campaign” to promote improved use of antibiotics in acute care hospitals and in 2013;16 the CDC highlighted the need to improve antibiotic use as one of four key strategies required to address the problem of antibiotic resistance in the U.S.1
A growing body of evidence demonstrates that hospital based programs dedicated to improving antibiotic use, commonly referred to as “Antibiotic Stewardship Programs (ASPs),” can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. These programs help clinicians improve the quality of patient care and improve patient safety through increased infection cure rates, reduced treatment failures, and increased frequency of correct prescribing for therapy and prophylaxis. They also significantly reduce hospital rates of CDI and antibiotic resistance. Moreover these programs often achieve these benefits while saving hospitals money. In recognition of the urgent need to improve antibiotic use in hospitals and the benefits of antibiotic stewardship programs, in 2014 CDC recommended that all acute care hospitals implement Antibiotic Stewardship Programs.
This document summarizes core elements of successful hospital Antibiotic Stewardship Programs. It complements existing guidelines on ASPs from organizations including the Infectious Diseases Society of America in conjunction with the Society for Healthcare Epidemiology of America, American Society of Health System Pharmacists, and The Joint Commission. There is no single template for a program to optimize antibiotic prescribing in hospitals. The complexity of medical decision making surrounding antibiotic use and the variability in the size and types of care among U.S. hospitals require flexibility in implementation. However, experience demonstrates that antibiotic stewardship programs can be implemented effectively in a wide variety of hospitals and that success is dependent on defined leadership and a coordinated multidisciplinary approach.
Suggested citation: CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/getsmart/healthcare/ implementation/core-elements.html.
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