Arjun Srinivasan, MD (CAPT, USPHS),
Arjun Srinivasan, MD (CAPT, USPHS),

Authors: Arjun Srinivasan, MD (CAPT, USPHS), Associate Director for Healthcare Associated Infection Prevention Programs, Division of Healthcare Quality Promotion, CDC, and Ed Septimus, MD, Medical Director, Infection Prevention and Epidemiology, HCA. Drs. Srinivasan and Septimus are co-chairs of the National Quality Partners’ antibiotic stewardship action team, convened by the National Quality Forum.

Today, CDC, in collaboration with the National Quality Forum (NQF) and Hospital Corporation of American (HCA), released Antibiotic Stewardship in Acute Care: A Practical Playbook, a practical guide developed to significantly reduce antibiotic misuse and overuse in hospitals. The Playbook represents recommendations and real-world examples from more than 25 professional societies and national stakeholders, who provided input and guidance.

Antibiotics are powerful tools to treat serious infections and can be life-saving for patients with sepsis. However, decades of overprescribing and misuse have resulted in bacteria that are increasingly resistant to these potent drugs, creating a growing threat of new superbugs that are difficult, and sometimes even impossible, to treat. The CDC estimates that drug-resistant bacteria cause two million illnesses and 23,000 deaths in the United States, annually.

CDC’s Core Elements of Hospital Antibiotic Stewardship Programs  recommends that all acute-care hospitals in the United States implement an antibiotic stewardship program to improve antibiotic use. The Playbook, which is based on CDC’s Core Elements, offers practical strategies for implementing high-quality antibiotic stewardship programs in acute-care hospitals nationwide:

  1. Leadership Commitment. Antibiotic stewardship is a team sport in which many hospital staff—including physicians, pharmacists, nurses, and administrators—play an important role.
  2. Accountability. Hospitals must appoint a single leader who is responsible for program outcomes.
  3. Drug Expertise. Hospitals must designate a single pharmacist who can lead initiatives to improve antibiotic use among patients.
  4. Action. Hospitals must implement a systematic approach to evaluating patients’ needs for antibiotics.
  5. Tracking. Monitoring the impact of antibiotics on patients and patient outcomes is essential to ensuring that antibiotics are prescribed only in cases where they can actually treat bacterial infections.
  6. Reporting. Doctors, nurses, and other key staff must regularly share information with all hospital stakeholders.
  7. Education. Education must be provided regularly to all hospital staff, as well as patients and their families.

The Playbook responds to a national call to action to address this national health priority. It seeks to provide a range of practical strategies to guide implementation of antibiotic stewardship programs and to help hospitals comply with CDC’s Core Elements. Investment in antibiotic stewardship programs has demonstrated improved patient outcomes, reduced antibiotic resistance, lives saved, and reduced healthcare costs. Hospital leaders play a critical role in ensuring that staff prescribe antibiotics only in cases where they can improve health outcomes.

Looking ahead, many additional areas need to be addressed to fully advance the nation’s stewardship of antibiotic use. For example, state and local health departments could serve as valuable resources to support antibiotic stewardship efforts. Public health can coordinate stewardship across the continuum of care in communities or regions. In addition, antibiotic drug discovery and development, rapid diagnostics, and surveillance are significant areas that demand further work.

As a key and immediate next step, hospitals can use the Playbook’s flexible framework to improve patient safety by implementing strategies that promote appropriate and safe antibiotic use.

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