Kathy Talkington and Joe Swedberg - Antibiotic Stewardship – Recent Activities in Human Medicine and Animal Agriculture

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This document summarizes recent activities related to antibiotic stewardship in human medicine and animal agriculture. It discusses progress in hospital antibiotic stewardship programs in the US, with the percentage of hospitals meeting CDC core elements increasing from 41% in 2014 to 64% in 2016. For human outpatient antibiotic use, 30% of prescriptions were deemed unnecessary. In animal agriculture, alternatives to antibiotics show promise for growth promotion and disease prevention in chickens. Upcoming priorities include finalizing federal policies on antibiotic stewardship, improving data collection and quality of programs, and prioritizing research on non-antibiotic alternatives.

Health & Medicine

Antibiotic Stewardship – Recent Activities in Human
Medicine and Animal Agriculture
NIAA
KathyTalkington,Director
Antibiotic ResistanceProject November 2018

Antibiotic Resistance: A Single Problem that
Requires Two Solutions
Slow the growth of resistance through conservation
Infection control, reducing inappropriate antibiotic use in humans and
animals, and making better use of existing drugs
Find new drugs to address inevitable resistance
Reducing barriers, and increasing incentives to develop new antibiotics
2

Stewardship = careful & responsible management of
resources
Antibiotic
stewardship
Keep antibiotics
effective
humans
animals
Avoid
unintended
consequences
human health
animal health
environment

5
Progress in Hospital Antibiotic Stewardship Programs
Inpatient Antibiotic Stewardship Data from CDC Antibiotic Resistance Patient Safety Atlas
gis.cdc.gov/grasp/PSA/indexST.html
41%
48%
64%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2014 2015 2016
Percentage of U.S. acute care hospitals reporting an antibiotic
stewardship fully meeting CDC’s Core Elements, 2014–2016

Federal Policy Actions - Inpatient Policy
Activities for Stewardship
• August 2016 - CMS Proposed rule for Conditions of Participation for
hospitals – Still Not Finalized
• CMS Conditions of Participation for Long-term care facilities (finalized
2015 – will be implemented 2018) – Not Fully Implemented
• Joint Commission Standards on Antibiotic Stewardship went into effect January
2017 – Need Improvement on quality
6

Inappropriate Outpatient Antibiotic Use
• Pew, CDC, and a panel of experts
analyzed 2010-2011 data from
the National Ambulatory
Medical Care Survey and the
National Hospital Ambulatory
Medical Care Survey
• This analysis found that at least
30% of outpatient antibiotic
prescriptions were unnecessary
7

What’s Next on Human Stewardship
• COPs
• Continuous quality improvement of stewardship programs
• Improved data reporting – NHSN
• Better understanding of behavioral drivers and incentives for
outpatient

New FDA Strategic Plan on Antibiotics
10

Research needs: How to reduce the need for
antibiotics ?
Management practices
Alternative products
(e.g., vaccines)
Other strategies (e.g.,
disease-resistant breeds)

Several product types hold promise as antibiotic alternatives
Current options for growth
promotion & prevention
http://www.pewtrusts.org/~/media/assets/2017/07/alternatives_to_ant
ibiotics_in_animal_agriculture.pdf
• More products have shown efficacy
for growth promotion & disease
prevention than for treatment
• Currently more products exist with
proven efficacy for chicken than for
other species
• Alternatives often have a narrower
spectrum of action & lower efficacy
than traditional antibiotics
• Efficacy often varies across trials for
largely unknown reasons

Pew – Farm Foundation Stewardship Work
Tag Team update

What’s next on Animal Stewardship
• Common understanding of core components of antibiotic stewardship
• Continued implementation of stewardship
• Improved data
• Veterinary oversight of all medically important antibiotics
• Antibiotic labels align with judicious use principals
• Prioritize research on alternatives
• Continuous quality improvement

More than half of all hospital patients are treated with antibiotics and prescribing practices vary widely, even within hospitals. Efforts to rationalize antibiotic use have been stymied by delays in obtaining specific diagnoses, by the volume of prescriptions written each day and by the difficulty of extracting meaningful data from scattered clinical, laboratory and pharmacy records. But the push is on – from the White House, the CDC, infectious disease specialists, the industry – for more judicious use of antibiotics through antibiotic stewardship programs. Hear how leading health care institutions have moved from education to active surveillance to intervention, reducing infections and lowering costs.

Stewardship Presentation MRPRC

Nathan Peterson

A pharmacist-led antimicrobial stewardship program using clinical decision support software led to improved antibiotic use and cost savings at a 260-bed community hospital. The program identified opportunities for intervention through a daily CDS report, allowing the pharmacist to optimize antibiotic therapy and reduce costs by $40,110 per month through interventions like de-escalating broad-spectrum antibiotics and switching IV to oral medications. Provider education also helped reduce fluoroquinolone use for urinary tract infections from 64% to 17% in alignment with local resistance patterns. Clinical decision support is a valuable tool for pharmacists to lead antimicrobial stewardship programs, especially in community hospital settings.

Atb steward

Islam Ibrahim

Antibiotic stewardship programs aim to optimize antibiotic use, improve patient outcomes, reduce antibiotic resistance and adverse events. They involve multidisciplinary teams who provide guidance and feedback on prescribing. Core elements include leadership commitment, accountability, drug expertise, tracking antibiotic use and resistance over time, and educating prescribers. Specific interventions target broad antibiotic use as well as infection-specific treatment protocols. Regular reporting and education helps ensure optimal antibiotic stewardship.

Antibiotic Guardian Birmingham Workshop

4 All of Us

Antibiotic resistance is one of the biggest threats facing us today! European Antibiotic Awareness Day (EAAD) is part of the UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, which focuses on antibiotics and sets out actions to slow the development and spread of antimicrobial resistance. This year, to run in line with EAAD; Public Health England has established the Antibiotic Guardian pledge campaign. It calls on everyone in the UK, the public and healthcare community to become antibiotics guardian by choosing one simple pledge about how they will make better use of these vital medicines. To ensure that the information and knowledge on Antibiotic Stewardship is disseminated to those practising healthcare across the nation, a series of awareness and educational events have been developed. These educational workshop events, to be held in Leeds, Birmingham and London, will provide guidance, resources and information for practitioners on topics associated with antibiotic awareness. The events will provide an opportunity to understand how you and your organisation can support combat the global challenge faced by antibiotic resistance whilst gaining advice, support and resources to inform patients and staff.

Advisor Live: Advancing Antimicrobial Stewardship

Premier Inc.

Advisor Live: Antimicrobial Stewardship - Why Now and How?

Premier Inc.

This 90-minute webinar discusses strategies and tools for implementing antimicrobial stewardship programs, including methods for measuring antimicrobial use and resistance. Join Premier’s free Advisor Live® webinar series for a special Get Smart About Antibiotics Week presentation on Thursday, November 19 from 12-1:30 p.m. EST. The panel for this 90-minute webinar will discuss strategies and tools for implementing antimicrobial stewardship programs, including methods for measuring antimicrobial use and resistance. EXPERT PRESENTERS: - Gina Pugliese, RN, MS, vice president, Premier Safety Institute®, moderator - Arjun Srinivasan, MD, (CAPT, USPHS) medical director of the CDC’s Get Smart for Healthcare program, will highlight the national focus on antibiotic stewardship and reasons for the current urgency - Michael Postelnick, RPh, BCPS AQ- Infectious Diseases, clinical manager and senior infectious diseases pharmacist for Northwestern Memorial Hospital, will share lessons learned from implementing their antibiotic stewardship program - Craig Barrett, Pharm.D., BCPS, director safety solutions for Premier, Inc. will share strategies from Premier member hospitals striving for antimicrobial stewardship

NHS Improvement AMS Workshop London 5th May

4 All of Us

Hosted by both NHS Improvement and Public Health England, this workshop, intended for NHS staff involved with antimicrobial stewardship activities within primary care; commissioning organisations; acute, community and mental health care provider organisations. 1. Learn about what is new in 2016-17 – AMR CQUIN & Quality Premium; PHE Fingertips; Behavioural strategies for AMR 2. Sharing success – learn about what worked well 3. Discuss what this means for your local health economy 4. Start planning local AMR networks – what might these look like? How to get started

Antimicrobial stewardship

drakmane

This document discusses antimicrobial stewardship and the role of microbiologists in stewardship programs. It notes that excessive antimicrobial use has led to increased resistance, and that 30-50% of antimicrobial use may be unnecessary. Antimicrobial stewardship programs aim to optimize antimicrobial use through education, formulary restrictions, prior approval programs, and prospective audits. The document emphasizes that microbiologists should be core members of stewardship teams by providing surveillance data on local resistance trends, patient-specific information to guide therapy, and ensuring high quality specimen collection and reporting to support optimal antibiotic use.

The document outlines proposed meaningful use criteria and objectives for 2011 that focus on improving quality, safety, efficiency, engaging patients and families, improving care coordination, improving population and public health, and ensuring privacy and security protections. It provides details on specific objectives and associated measures within each category. The summary recommends having a clear understanding of the meaningful use requirements and vendor solutions to meet them.

BioTek Overview

BioTek Labs, LLC

BioTek Labs provides allergy testing and immunotherapy treatment services within medical practices to improve patients' quality of life from environmental allergies, with BioTek employees performing the testing onsite and managing the customized immunotherapy treatment protocols over the course of a year in order to benefit patients, providers, payers, and employers. BioTek aims to build long-lasting relationships with medical groups by delivering a turn-key allergy testing lab and treatment program within practices with no upfront costs to improve patient care and generate added revenue.

Antibiotic policy

Dr Chinmay Dash

This document outlines recommendations for developing and implementing an antibiotic policy in hospitals. It discusses formulating the policy based on local antimicrobial susceptibility data. The policy should include guidelines for empiric, prophylactic, and definitive antibiotic therapy along with restricted and reserve drug lists. It recommends establishing an antibiotic management team to monitor implementation and assess outcomes, such as antibiotic consumption. Regular review and updating of the policy based on new clinical and susceptibility data is also advised. The overall goal is to optimize antibiotic use and slow the development of antimicrobial resistance.

Measuring Medicine Prices

MeTApresents

Antimicrobial Stewardship ,Heba Abdallatif,BCPS

Heba Abd Allatif

The document provides an overview of antimicrobial stewardship programs and antibiotic resistance. It discusses how antibiotic overuse has led to increased resistance [1]. Antimicrobial stewardship programs aim to optimize antibiotic use and slow resistance through coordinated actions [2]. The core elements of effective programs include leadership commitment, accountability, drug expertise, tracking antibiotic use and resistance, reporting on improvement efforts, and education [3]. Targeted strategies are needed given the unique challenges of prescribing antibiotics for neonatal intensive care patients. Bundles of evidence-based practices can help reduce healthcare-associated infections like CLABSIs in the NICU.

Quality Improvement in HIV Clinics

suchiey

One in every 20 adults in Uganda lives with HIV/AIDS. The Healthcare Improvement Project works to improve healthcare quality and efficiency in countries like Uganda that have a shortage of healthcare workers. The project uses a collaborative approach where teams of healthcare workers identify inefficient processes, develop improvements, and share results with other teams. An evaluation of the project's Data Management Collaborative in Uganda found that clinics significantly reduced record retrieval times and clinic hours through quality improvement interventions. A cost-benefit analysis showed the project provided a net benefit of over $82,000 per year.

Antimicrobial Stewardship

Apollo Hospitals

This presentation discusses antimicrobial stewardship and the challenges of implementing stewardship programs globally. It notes the lack of infectious disease physicians and pharmacists in some countries. Effective stewardship requires a multidisciplinary team approach and overcoming barriers like lack of funding, open antibiotic access, and cultural resistance to change. The presentation highlights strategies that have worked in various settings, including technology solutions, empowering patients, identifying high-risk patients, and education programs. Measuring outcomes like reduced length of stay and improved patient outcomes can demonstrate the impact of stewardship.

Hospital Antibiotic Stewardship Programs - Qualitative analysis of numerous h...

Madiha Mushtaque

Antimicrobial stewardship programs (ASP) are an essential practice to prevent increasing resistance against antibiotics. A successful ASP monitors not only prescribing patterns and practices but also contributes in minimizing the toxic effects of antibiotics. Moreover, ASP also facilitates the selection of disease specific antibiotics and enforces rules and regulations to rationalize the use of antibiotics. The aim of the study is to highlight the core elements of Hospital Antibiotic Stewardship Programs in Karachi. The key elements proposed by center of disease control (CDC) such as; leadership, accountability, drug expertise, actions to support optimal antibiotic use, tracking (monitoring antibiotic prescribing, use and resistance), reporting information to staff on improving antibiotic use and resistance and education were evaluated on Yes/No scale. The data was collected from 44 hospitals of different categories in Karachi and all the major elements were studied. It was observed that all the hospitals in one setting failed to comply with all the guidelines. It has been concluded that efforts should be made to design ASP at each hospital and implemented through suitable policies and procedures.

Antibiotic stewardship program

Society for Microbiology and Infection care

The document discusses the importance and components of antibiotic stewardship programs. It notes that antimicrobial resistance is increasing as development of new antibiotics is slowing. An antibiotic stewardship program aims to optimize antibiotic use, prevent resistance, and improve outcomes. Key components include monitoring antibiotic use, providing education to prescribers, and implementing guidelines and interventions to ensure appropriate antibiotic selection, dosage, and duration. The goals are to improve patient safety, reduce costs, and slow the development of drug-resistant bacteria.

Antibiotic Stewardship: A National and International Imperative

PYA, P.C.

Antibiotic stewardship programme hiht final 3nov2012

Vikas Kesarwani

The document discusses antimicrobial stewardship and its importance. It provides 3 key goals of antimicrobial stewardship programs: [1] Ensuring each patient receives the most appropriate antimicrobial, [2] Preventing overuse, misuse and abuse of antimicrobials, and [3] Minimizing the development of resistance. It also outlines some core strategies for antimicrobial stewardship programs, including formulary restrictions, preauthorization requirements, and prospective audit and feedback of antimicrobial usage.

Implementation of a quality system linked to economic incentives in a health ...

Josep Maria Vilaseca Llobet

ECO 11: Transfer of Care to Pharmacy - Hassan Argomandkhah, Chair of Pharmacy...

Innovation Agency

Medicines optimisation, pop up uni, 9am, 3 september 2015

NHS England

Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event. Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development. This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being. More information is available online: www.expo.nhs.uk

Innovation in patient care

Amit Garg

Antimicrobial stewardship CME 04-03-19

Tahseen Siddiqui

The document outlines an antimicrobial stewardship program that aims to optimize antibiotic use through a multidisciplinary team approach. It discusses how pharmacists monitor antibiotic use daily for appropriateness, look for opportunities to convert IV antibiotics to oral ones when possible, review culture data to de-escalate broad spectrum antibiotics, and perform therapeutic drug monitoring. It also describes how the infection control team tracks emerging resistance, analyzes healthcare-associated infections, and incorporates stewardship into broader infection prevention efforts through annual antibiogram reviews and periodic evaluations of antibiotic use. The overall goal is to improve patient outcomes while containing costs and slowing the development of resistance.

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ECO 11: Medicines Optimisation Through Precision - Sir Munir Pirmohamed

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