Why should antibiotic stewardship be important to the patient?
Why should antibiotic stewardship be important to the patient?
September 2, 2023
Joy Stepinski, MSN, RN-BC
According to the Centers for Disease Control and Prevention (CDC), antibiotics have advanced medical care by treating previously known fatal conditions and extending life. Yet, the inappropriate use of these medications can contribute to antibiotic resistance, adverse risks (like C. diff), longer hospital stays, higher medical costs, and negatively affect population health [1]. In fact, antibiotic resistance can be a factor to medical harm, causing 2 million infections and 23,000 deaths annually [2]. Judicious use of antibiotics is therefore important, yet the CDC relates that 30% of prescribing in both inpatient and outpatient settings are not necessary [1, 2].
Healthcare professionals have the responsibility to use antibiotics in a thoughtful manner. Efforts include:
· Reviewing patient medical history for infection risk (such as chronic disease and immunocompromised conditions),
· Ascertaining true life-threatening allergies from unwanted site effects (antibiotic allergies can lead to less appropriate or broad-spectrum antibiotic prescription and higher risk of antibiotic resistance) [3],
· Communicating effectively among the healthcare team,
· Obtaining only necessary specimens,
· Monitoring the patient response to the medication to transition from intravenous medication to an oral route,
· Prescribing an antibiotic that is most effective with the least duration, and
· Coordinating discharge planning and patient education of the antibiotic therapy.
Patients who are hospitalized are more prone to healthcare-associated infections (HAIs), which is acquired as a result of healthcare- related interventions. The CDC reports that one in 31 patients is documented with an HAI on any day [4]. Certain risk factors, such as immobility, immunocompromise, change in nutrition, and chronic disease can place the patient at higher risk [5]. HAIs are infections related to central lines (special types of intravenous catheters that sit close to the heart), urinary catheters, ventilators, surgery, and pneumonia [4]. Although many measures are in place to mitigate HAI risk, acquiring an infection leads to the need for antibiotics.
Awareness of antibiotic use is not only important with inpatient and outpatient care, but also in the dentist chair. In a new study published just last month [6], the authors relayed that dentists are among the top antibiotic prescribers. In this retrospective study between 2012 and 2019, dentists were discovered to write over 216 million prescriptions. The prescribing rate remained steady over that time period. However, in the northeastern United States the frequency increased, rather than decreased [7].
Patients have an important role of advocating for themselves with respect to antibiotic use. Some suggestions are:
· Question the need for the medication.
· Work with your doctor to take the antibiotic for the shortest time as possible if the medication is absolutely necessary*.
· Avoid hospital-acquired infections by walking and moving around as much as possible, brushing your teeth [4], and eating optimally (plant-based foods) while hospitalized [8].
*One research review discusses that while overuse of antibiotics is shown to cause bacterial resistance, the lack of recommended antibiotic duration is limited [9]. Some cases suggests that while shorter treatment may reduce the medication effectiveness, several investigations show that shorter treatment leads to the same efficacy with lower infection recurrence rates and less risk of resistance. Additionally, depending on medical conditions and other disease-related factors, patients can respond differently to the same antibiotic. The duration may best correspond with the patient’s overall picture, rather than standard treatments.
Understanding antibiotic stewardship, implications of antibiotics to health, and current research can help patients make informed decisions about care!
References:
1. Centers for Disease Control and Prevention. (2021). Core elements of hospital antibiotic stewardship programs. https://www.cdc.gov/antibiotic-use/core-elements/hospital.html
2. Centers for Disease Control and Prevention. (2021). Core elements of outpatient antibiotic stewardship. https://www.cdc.gov/antibiotic-use/core-elements/hospital.html
3. Olans, R. N., Olans, R. D., & Witt, D. J. (2017). Good nursing is good antibiotic stewardship.
4. Centers for Disease Control and Prevention. (2014). Types of healthcare-associated infections. https://www.cdc.gov/hai/infectiontypes.html
5. Stepinski, J., Rowe, S., & Robertson, R. (2022). Impact of an Oral Care Intervention among Medical-Surgical Patients. MEDSURG Nursing, 31(2), 91 – 98.
6. Ramanathan, S., Yan, C. H., Hubbard, C., Calip, G. S., Sharp, L. K., Evans, C. T., ... & Suda, K. J. (2023). Changes in antibiotic prescribing by dentists in the United States, 2012–2019. Infection Control & Hospital Epidemiology, 1-6.
7. Dall, C. (2023). Study shows no change in US dental antibiotic prescribing rates. https://www.cidrap.umn.edu/antimicrobial-stewardship/study-shows-no-change-us-dental-antibiotic-prescribing-rates
8. Saldivar, B., Al-Turk, B., Brown, M., & Aggarwal, M. (2022). Successful Incorporation of a Plant-Based Menu Into a Large Academic Hospital. American Journal of Lifestyle Medicine, 16(3), 311-317. https://doi.org/10.1177/15598276211048788
9. Llewelyn, M. J., Fitzpatrick, J. M., Darwin, E., Gorton, C., Paul, J., Peto, T. E., ... & Walker, A. S. (2017). The antibiotic course has had its day. British Medical Journal, 358. https://doi.org/10.1136/bmj.j3418