While many microbes are important to our good health, some can cause disease and make us very ill. When this happens, an antimicrobial may be prescribed to help fight the disease. Many of us are most familiar with antibiotics, a kind of antimicrobial, intended to combat harmful bacteria inside the body.
“Antibiotics are a limited resource, meaning bacteria can become more resistant if antibiotics are not used appropriately,” says Dr. Pavani Das, Antimicrobial Stewardship Physician Lead.
Since 2009, North York General Hospital (NYGH) has been auditing its use of antimicrobials. As a patient safety quality initiative, it created its own Antimicrobial Stewardship Program (ASP) in 2011. The program coordinates efforts to:
- Impact adverse patient events
- Combat the emergence of antibiotic resistant organisms
- Improve and measure the appropriate use of antimicrobials
Supporting improved patient outcomes and safety
A successful antimicrobial stewardship program curbs the development of resistant pathogens by encouraging responsible antibiotic use as well as a routine review of guidelines with prescribers. This leads to promoting proper antimicrobial therapy for all patients. “Good stewardship of antibiotics should help health practitioners use the right antibiotic, at the right time, in the right dose, for the right duration,” says Dr. Das.
NYGH's Antimicrobial Stewardship Program develops and implements a variety of strategies to counter the development and multiplication of microbes in the hospital's inpatients.
“Our most successful strategy has been the use of audit and feedback, a mechanism by which we discuss antibiotic decision-making with prescribers (regulated health professionals) in real-time, and provide them with important feedback to optimize their choices as the patient's therapy is in progress,” says Sumit Raybardhan,Infectious Disease Pharmacy Practitioner.
Antimicrobial Stewardship Pharmacist Tiffany Kan explains that they review antibiotic use within the hospital, and collaborate within an interdisciplinary environment to provide feedback to clinicians in order to optimize antimicrobial prescribing and improve patient outcomes and safety. They make recommendations on an individual patient level, but also consider the broader impact of these antimicrobial decisions in the hospital's environment.
“Education of our hospital staff, physicians and learners is also a critical aspect of our program. Our aim is to create a culture of antimicrobial stewardship among our clinicians and future health care professionals so that everyone recognizes the role and responsibility they have to preserve our antibiotic resources,” says Tiffany.
As an ASP physician, Dr. Das makes herself available as a reliable resource for optimal antibiotic utilization and guidance to her physician colleagues. “I also strive to support the day-to-day functions of our pharmacists as well as our ASP team to ensure we are providing a comprehensive approach to our antibiotic recommendations that arise from both clinical considerations and current evidence.”
Success in reducing infection rates
NYGH's ASP is now over seven years old and a new culture of antimicrobial stewardship throughout the organization is growing.
“Better understanding of the various drivers of unnecessary antimicrobial use increased as a result of our focused interdisciplinary work with prescribers,” says Sumit. “A major win for ASP was when our efforts recently culminated in NYGH having the lowest rates of C difficile infections (a common health care-associated infection that is associated with antibiotic use) among our peer hospitals in the GTA.”
Left: The Antimicrobial Stewardship Program team from left: Tiffany Kan, Antimicrobial Stewardship Pharmacist; Sumit Raybardhan, Infectious Disease Pharmacy Practitioner; and Dr. Pavani Das, Antimicrobial Stewardship Physician Lead.
In collaboration with other Toronto hospitals, our Antimicrobial Stewardship Program is creating systematic ways of evaluating patients who report that they have a penicillin allergy. While penicillin allergies are the most common drug allergy reported by patients in health care, statistics show that less than 1% of those patients are truly allergic.
“When a patient reports a penicillin allergy, the available antibiotics we have to treat them with is limited, and they end up getting less than optimal antibiotics for their infection,” says Sumit. “The work we do in this area will help ensure patients receive the safest, most effective care.”
A common perception may be that antibiotics are useful and harmless in common health care scenarios, such as using them for the common cold (antibiotics only combat bacteria not viruses).
However, antimicrobial resistance is increasing due to overuse and misuse. Additionally, new antimicrobial drug development is slowing. “We need to approach antibiotic use in the same way we approach the use of water — this resource is precious, misuse or overuse is detrimental to people and the environment,” says Dr. Das. “Our responsibility to future generations is to use antimicrobials with caution and careful consideration for the inevitable risks.”