In doctors’ offices and hospitals across the country, nearly one-third of all antibiotics are unnecessary or prescribed incorrectly1.
Overuse and misuse of antibiotics contributes significantly to the problem of antibiotic resistance. But, the more these drugs are used, the bacteria they are meant to destroy become more resistant. As more bacteria become resistant to the drugs that we rely on, we face a future where routine surgery, strep infections, pneumonia, childbirth, or even seemingly minor skin infections could become life-threatening.
While we eagerly await the discovery and approval of new and novel antibiotics and antimicrobials — and are excited by public policy proposals that would streamline these efforts — we are buoyed by the enthusiasm for implementing antibiotic stewardship programs. These programs are designed to improve the use of antibiotics to enhance patient outcomes, reduce costs of care and stem multi-drug resistant organisms. Antibiotic stewardship strategies align hospitals and health systems on a central vision to help prolong the efficacy of antibiotics and meet the threat of new resistant microbes. Research shows that they’re making an impact, too, helping to reduce antibiotic prescribing by 5 percent from 2011 to 20142, but more needs to be done to accelerate our understanding of how best to optimize these strategies across different healthcare settings.
Investigating the socio-behavioral factors behind antibiotic prescribing to identify the non-clinical drivers of inappropriate prescribing will help us design better, more effective interventions. This field of science identifies effective approaches to changing behavior of medical professionals across various settings, establishing systems that help them consistently incorporate research findings and evidence-based practices into the routine care of patients.
Research like this is critical for stewardship programs to work effectively but unfortunately, a lack of resources keep stewardship programs from building in this area. For example, many facilities are rich with data and experience that could provide valuable information, but they lack the staff, time and vision to conduct the research and analyze the data and make their learning available to others.
Recently, the Society for Healthcare Epidemiology of America hosted the third Antimicrobial Stewardship Research Workshop to address this need for a stronger knowledge base for implementing practice-changing stewardship programs. These workshops provide participants the tools to develop and measure evidence-based stewardship approaches, as well as implement novel research techniques in healthcare settings to help continually evolve and optimize them. Through these workshops we have found many researchers in hospital systems and healthcare facilities are doing exceptional work conducting research in-house to expand the evidence base for what works.
For instance, Mary Staicu, PharmD, a clinical pharmacy specialist in infectious diseases at Rochester General Hospital, recently verified a tool that helps physicians know when to retest patients who are being treated with less-than-optimum antibiotic choice for their conditions because of a previously identified penicillin allergy. As a result of her research, other infectious disease experts are using her findings to implement the tool into their own institutions, improving patient outcomes.
Dr. Staicu’s work is just one example of the impact that implementation science can have, not only on antibiotic stewardship, but on the health and safety of patients. We need more support for this kind of research through resource allocation from hospital and healthcare systems leadership, as well as funding from other sources.
Without real action, antibiotic resistance will continue to threaten patients, increase healthcare costs and eliminate valuable drug interventions, setting modern medicine back decades. Healthcare systems must invest in making strong antimicrobial stewardship a way to practice and deliver care based on a team-approach. The stakes are too high to fail in providing resources for this critical area of medical research. Funding and support for ongoing research into implementation science is critical to preventing inappropriate use of antibiotics and slowing the development and spread of resistant bacteria so we don’t go backwards in our ability to save lives.
Elizabeth Dodds-Ashley, PharmD, MHS, liaison pharmacist with the Duke Antimicrobial Stewardship Outreach Network based at Duke University and co-chair of the Antimicrobial Stewardship Research Workshop, hosted by the Society for Healthcare Epidemiology of America
Jeffrey Gerber, MD, PhD, attending physician in the Division of Infectious Diseases at Children's Hospital of Philadelphia and co-chair of the Antimicrobial Stewardship Research Workshop, hosted by the Society for Healthcare Epidemiology of America
1 CDC. Antibiotic Use in the United States, 2017: Progress and Opportunities. Atlanta, GA:
US Department of Health and Human Services, CDC; 2017.
2 CDC. Antibiotic Use in the United States, 2017: Progress and Opportunities. Atlanta, GA:
US Department of Health and Human Services, CDC; 2017.