ABX: Antimicrobial Stewardship

Why We Want to Improve Antibiotic Stewardship

Antibiotics are some of the most widely prescribed drugs in medical practice, yet, according the Centers for Disease Control and Prevention (CDC), up to 50 percent of all antibiotics prescribed are either not necessary or are not effective as prescribed; this has become widely recognized as a top public health priority. Antibiotic stewardship initiatives are a crucial measure in preventing the overuse and misuse of antimicrobials.

Overuse of antibiotics can lead to C. difficile infection (C. diff), a dangerous infection that cause illness ranging from diarrhea to sepsis and even death. C. diff is estimated by the CDC to have caused almost half a million infections in the United States in 2011. Approximately 83,000 of the patients who developed the infection experienced at least one recurrence, and 29,000 people died within 30 days of the initial diagnosis. The economic impact of C. diff is similarly devastating; According to the CDC’s March 2012 Vital Signs report, C. diff alone cost at least $1 billion in extra healthcare costs annually.

Inappropriate antibiotic use can also lead to antibiotic-resistant (AR) organisms. Persons infected with AR organisms are more likely to require longer hospital stays, require combinations of antimicrobials and require the use of drugs considered second or third choice. These factors are often associated with greater toxicity and length of hospitalization, as well as higher cost of care. In addition to direct patient harm, AR in the United States costs an estimated $20 billion a year in healthcare costs, $35 billion in other societal costs and more than 8 million additional days spent by patients in the hospital.

Preventing AR and C. diff requires hospitals to use a proactive approach that includes antimicrobial stewardship, clinician education and patient and family engagement around proper use of antibiotics.