The important role data and analytics play in successful antibiotic stewardship is on full display in a 40-page status report on antibiotic use released by the Centers for Disease Control and Prevention¹.
Running through the report, 2017 Antibiotic Use in the United States: Progress and Opportunities, is the unmistakable admonition from the CDC that what gets measured gets improved. What must improve is the use of antibiotics by ambulatory care facilities, nursing homes and hospitals to fight infections. And the way to improve it is by collecting and analyzing data to determine how well providers are adhering to evidence-based best practices for administering bacteria-fighting medications to patients.
Four benefits of effective antibiotic stewardship
The CDC identified antibiotic stewardship as one of four strategies to fight the growing threat to public health from antibiotic-resistant bacteria, or infection-causing germs that don’t respond to medication. The other three strategies are:
- Preventing infections and the spread of antibiotic-resistant bacteria
- Tracking infections and infectious outbreaks
- Developing new drugs and diagnostics
The agency defined antibiotic stewardship by health care providers as “using the right antibiotic at the right dose for the right duration and at the right time.” According to the CDC report, successful antibiotic stewardship can generate four benefits for patients, providers, payers and the public:
1. Improve patient outcomes. By reducing unnecessary antibiotic prescribing, antibiotic stewardship programs and activities can improve the treatment of infections and prevent avoidable side effects, reactions and other problems for patients.
2. Decrease C. difficile infections. Antibiotic stewardship programs and activities significantly reduce C. difficile infections. For example, reducing the use of high-risk antibiotics (fluoroquinolones) by 30 percent can lower C. difficile infections by 26 percent in hospitals, according to one study. Reducing overall antibiotic prescribing in outpatient settings by 10 percent could lower C. difficile infections in the community by 17 percent, according to another study.
3. Decrease antibiotic resistance. Preventing infections and improving antibiotic prescribing could save 37,000 people from dying from antibiotic-resistant infections over a period of five years.
4. Decrease costs. Antibiotic stewardship programs have consistently demonstrated annual savings of $200,000 to $400,000 per hospital and other health care facilities. According to one study, implementation of an antibiotic stewardship program saved one hospital a total of $17 million over eight years.
How the CDC supports provider-level antibiotic stewardship programs with data
With such laudable benefits, the challenge for ambulatory care facilities, nursing homes and hospitals is how to get there faster. Per the CDC report, the key is performance data. The agency itself is working on two tracks to supply actionable data to providers to support their antibiotic stewardship programs. The CDC is:
- Providing data about facility-level antibiotic use in outpatient settings, hospitals and nursing homes to help health care providers identify opportunities to improve prescribing.
- Working with partners to develop a benchmark for hospitals to assess their antibiotic use and monitor the impact of antibiotic stewardship programs.
“One of the most important ways the CDC can help improve antibiotic use is to produce and analyze data to support health care facilities and providers in making the best choices for their patients,” the report said.
How health care providers can use data to support their own antibiotic stewardship programs
If performance data aren’t readily available from the CDC or another public health agency like a state health department, providers can – and should – do it themselves.
According to the report, one of the four core elements of an outpatient antibiotic stewardship program is tracking and reporting. The CDC recommends that ambulatory care facilities should monitor antibiotic prescribing practices and offer regular feedback to providers, or have providers assess their own antibiotic prescribing practices.
The agency also said that the same tracking and reporting protocols should apply to all outpatient care settings, including those not normally associated with a need for antibiotics that write prescriptions anyway, exacerbating the problem of antibiotic-resistant bacteria. Those settings include convenient care, urgent care, retail health clinics and dental practices.
Nursing homes also suffer from a dearth of data on antibiotic prescribing practices, according to the report. The sparse information that is available suggests some serious shortcomings. The CDC said the most common prescribing problems in nursing homes are:
- Using an antibiotic when not needed
- Choosing the wrong antibiotic
- Using the correct antibiotic but in the wrong dose or duration
Tracking and reporting are also core elements of an antibiotic stewardship program for nursing homes. The CDC recommended that nursing homes monitor at least one process measure of antibiotic use and at least one outcome from antibiotic use. The agency also recommended that nursing homes provide regular feedback on antibiotic use and resistance to prescribing clinicians, nurses and other staff.
Hospitals, unlike outpatient care facilities and nursing homes, are swimming in antibiotic use data. The challenge for hospitals is making the data useful through analytics and acting on what the results tell them in terms of deviations from best practices.
Citing numerous studies, the CDC’s report said one-third of antibiotic medications dispensed in hospitals involve problems such as:
- Giving an antibiotic without proper testing or evaluation
- Prescribing an antibiotic when it is not needed
- Giving an antibiotic for too long
Like outpatient care sites and nursing homes, hospitals include tracking and reporting as core elements of their antibiotic stewardship programs. But the core elements also include leadership commitment and action. The CDC said hospital executives should dedicate the necessary human, financial and information technology resources to operate a successful antibiotic stewardship program. And the CDC said hospitals should implement at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment, such as an antibiotic “time out” after 48 hours.
As the CDC’s report illustrates, collecting, analyzing and reporting data on antibiotic use and then using that information to improve prescribing practices is the foundation of successful antibiotic stewardship.
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