Antibiotic resistance is an alarming and increasing threat to global public health. According to the Centers for Disease Control and Prevention (CDC), two million people a year become infected with bacteria resistant to antibiotics and lead to 23,000 deaths in the United States alone. Simply put, the bugs are getting stronger and smarter, our antibiotic arsenal has not kept pace, and we have overused our antibiotic resources in a manner that is not sustainable.
Regulatory measures are being developed to help curtail antibiotic overuse in both humans and animals, and research is underway to find new antibiotics. A critical component of protecting the efficacy of existing and new antibiotics is antibiotic stewardship. Antibiotic stewardship programs are a structured way to promote the optimal use of antimicrobials to improve patient outcomes, reduce antibiotic resistance, and decrease the spread of multidrug-resistant organisms and resulting infections.
As antibiotic stewardship becomes a critical strategy in hospitals, long-term care, post-acute care, physician offices, and clinics, its importance must be properly communicated to ensure implementation occurs and efforts are sustained. Specifically, success lies in creating a national culture of understanding when and how antibiotics should be used.
Front-line providers need to adopt this culture with the support of leaders who are trained in the best ways to use antibiotics to treat infectious diseases. Changing long-standing habits can be challenging, but to improve prescribing practices, we must work collectively with all members of patient care teams to improve antibiotic prescribing. In addition, it is crucial to educate patients on how and when antibiotics work – or don’t – including them as knowledgeable members of their own healthcare team.
While most academic hospitals already have established antibiotic stewardship programs, at least half of acute care hospitals in the United States do not have these programs and the numbers are lower for other healthcare settings. All healthcare organizations must consider how to implement effective programs and are encouraged to seek expert leadership to develop them.
However, bestowing the title or responsibility of antibiotic stewardship leadership to a physician and pharmacist without also committing the necessary resources, including education and training, does not work. We can’t just check the box of creating antibiotic stewardship programs that exist in name only. Without real action, antibiotic resistance will continue to threaten patients, increase healthcare costs and threaten the utility of antibiotics. Healthcare systems must commit to making this a way to practice and deliver care based on a team-approach of invested individuals.
We can’t just fight this fight domestically. Because bacteria do not obey geographical borders, antibiotic resistance is really a global crisis. Recognizing the severity of the issue and addressing it in every setting is necessary to control and roll back antibiotic resistance. It is encouraging to receive support from the White House on the need to make antibiotic resistance and stewardship a priority. We can fight back, but only through commitment as a community united to address the issue head on, using evidence-based strategies, such as stewardship in clinical settings, and working together to provide our patients and our communities at large with better care.
Sara Cosgrove is an infectious diseases physician and vice chair, Society for Healthcare Epidemiology of America (SHEA) and chair, SHEA Antimicrobial Stewardship Committee. Whitney Buckel is a clinical pharmacist, and member, SHEA Antimicrobial Stewardship Committee.
