Each year more than two million people in the United States get infections that are resistant to antibiotics and at least 23,000 people die as a result.
Dr. Debra Palazzi, a pediatric infectious diseases specialist and medical director of Texas Children’s Hospital’s Antimicrobial Stewardship Program, said the hospital has a good history of keeping antibiotic resistance at bay, but that the organization isn’t immune to the worldwide problem and has seen an increase in such cases during the past few years.
“We now see children with complicated diseases for whom we have limited or no effective antimicrobial therapy,” Palazzi said. “This is a growing problem in our pediatric population and results in increased morbidity and mortality.”
To help raise awareness of antibiotic resistance and the importance of appropriate antibiotic prescribing and use, Texas Children’s Hospital is joining more than 20 children’s hospitals across the country this week to promote the Center for Disease Control and Prevention’s Get Smart About Antibiotics Week. The goals of the annual event are to raise awareness of antibiotic resistance and to educate health care providers and the public about the appropriate and safe use of antimicrobial therapy.
Palazzi and Ruston Taylor, the clinical pharmacy specialist for the Antimicrobial Stewardship Program, have been working hard to achieve both of those goals and formed earlier this year a multidisciplinary Antimicrobial Stewardship Program aimed at optimizing the selection, dose, duration and route of therapy given to patients at Texas Children’s Hospital. Since then, a member of the program’s team has reviewed microbiology reports daily to assist healthcare providers in prescribing the appropriate antimicrobial therapy.
In some cases, the stewardship team – which is composed of people from multiple departments including Pharmacy, Infection Control, Infectious Diseases, Microbiology, and Quality and Safety – makes a recommendation to improve a patient’s antimicrobial treatment plan. The recommendation might be to de-escalate therapy, use an alternative therapy or stop therapy altogether.
“When most people think of antimicrobial stewardship, they say ‘antibiotic police’,” Taylor said. “We’ve actually called providers to START a drug that’s active against a reported bacterial pathogen rather than calling for discontinuation of agents.”
Another tool the team uses to help optimize a patient’s treatment plan is a rapid diagnostic test that can identify the presence of certain antibiotic-resistant strains of bacteria in a few hours instead of days. Before the availability of the test, physicians had to wait on culture-dependent methods for identification, which could take two to three days. Now, results can be determined in about an hour, allowing physicians to prescribe more appropriate treatment sooner rather than later.
Another intervention developed by the Antimicrobial Stewardship Program team started in the Pediatric Intensive Care Unit (PICU) and has quickly spread to other parts of the hospital. This summer, members of the stewardship team began rounding with all PICU teams to introduce a care bundle for antimicrobial prescribing to their daily provider progress notes. The bundle addresses the infectious disease the team is trying to treat, the antimicrobial agents the patient is on, microbiology data obtained, and the plan for antimicrobial therapy.
“The appropriate use of antimicrobials is something that affects all of us,” Taylor said. “The choices we make today may have consequences for generations to come.”
For more information on Get Smart About Antibiotics Week and how you can help, visit http://www.cdc.gov/getsmart/week/.