How Intermountain researchers are helping smaller hospitals cut antibiotic use

Megan Knowles - Print  | 

Researchers at Salt Lake City-based Intermountain Healthcare and University of Utah Health completed a study establishing how community hospitals with fewer than 200 beds can create antibiotic stewardship programs that aim to prevent antibiotic-resistant bacteria growth, according to a study published in Clinical Infectious Diseases.

Although The Joint Commission requires hospitals across the U.S. to implement antibiotic stewardship programs that improve antibiotic prescribing, prior to the study, each participating hospital lacked antibiotic stewardship programs due to insufficient resources.

In the study, which spanned 15 months, researchers compared how three types of antibiotic stewardship programs affected 15 small hospitals within Intermountain Healthcare. To determine which program was most effective in reducing broad-spectrum antibiotic use, the researchers randomly assigned each hospital to one of three types of programs.

The researchers found using a centralized infectious disease support program reduced overall antibiotic use and the overuse of most broad-spectrum drugs, which target a number of disease-causing bacteria.

Program 1 started with basic education on antibiotic stewardship programs and a 24/7 infectious disease hotline, while program 2 built on these attributes. Program 3 had the most advanced antibiotic stewardship education programs, a 24/7 infectious disease hotline, a pharmacy-based initiative in which local pharmacists reviewed antibiotic prescriptions, a restriction of certain broad-spectrum antibiotics and a system in which infectious disease specialists reviewed selected microbiology results and discussed treatment recommendations with providers.

The study found program 3 to be the most effective. Only hospitals in program 3 saw a significant reduction in antibiotic use compared to baseline data, reducing broad-spectrum antibiotic use by 24 percent and total antibiotic use by 11 percent. On the other hand, the study authors found other programs that did not have central support failed to see an improvement in antibiotic use. 

"Having an antibiotic stewardship program in place that ensures the right antibiotic is used for the right patient, at the right time, in the right dose and route, and for the right duration will help us protect the effectiveness of the antibiotics we use," said lead study author Eddie Stenehjem, MD.

"The challenge has been knowing how these programs can be implemented in small hospitals, where, historically, they've been absent, even though antibiotic use rates in small hospitals are very similar to large hospitals, where the programs are typically found," Dr. Stenehjem added.

The researchers concluded these programs could help providers address the growing problem of "superbugs" and fight the costly and dangerous infections affecting hospitals. "The bottom line is, small hospitals cannot do it by themselves, but by sharing experts and resources within a system, they can really reduce the inappropriate use of antibiotics," said study author Andrew Pavia, MD.

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