UAB hospital leads the way in improving antibiotic use

One of today's urgent health threats is antibiotic resistance, caused by inappropriate prescription and use of antibiotics, and — according to the Centers for Disease Control and Prevention — approximately 50 percent of all antibiotics prescribed in the United States are unnecessary or inappropriate, with many of them prescribed in inpatient settings.

Inappropriate use of antibiotics increases the risk of developing Clostridium difficile, an illness that causes diarrhea and can be fatal if not treated properly.

The University of Alabama at Birmingham was featured in a report published in April by The Pew Charitable Trusts as one of 10 acute and long-term care facilities leading the way in improving antibiotic use.

"Our program has been successful in part because we focus on the appropriate inpatient use of all antimicrobial agents and collaborate efficiently with hospital epidemiology and infection prevention, the microbiology laboratory, and the hospital pharmacy," said Peter Pappas, M.D., chair of the UAB Antimicrobial Stewardship Program. "Our faculty and trainees understand the overuse and inappropriate use of antibiotics very often leads to bad outcomes such as the development of multidrug-resistant bacteria and fungi, hospital-acquired infections due to these difficult-to-treat organisms, and the development of C difficile intestinal infections. Through the cooperation of our collaborators and the physicians at UAB, our antimicrobial stewardship program has been able to positively impact each of these areas, and we have realized some important gains over the last few years since the initiation of the program. The hospital is a safer place in part because of the interventions."

The ASP program at UAB was created in 2008 and focuses on seven core elements, including leadership commitment, accountability, drug expertise, action, education, and the tracking and reporting of hospital antimicrobial prescribing.

The antibiotic stewardship program at UAB Hospital promotes the responsible use of antibiotics by taking actions such as measuring a facility's antibiotic use, providing infectious disease or pharmacy consultation for prescribers, requiring advance authorization before a physician can prescribe certain antibiotics, and tracking the results of these efforts. At monthly ASP meetings, the antibiotic stewards review antibiotic utilization data, the usage of all restricted antimicrobials and antibiotic expenditures.

Specifically, UAB uses computerized physician order entry and automated dispensing cabinets allowing for easy tracking and dispensing of antibiotics and bedside bar coding automatically documenting and verifying the administration of medication.

UAB has an on-site microbiology laboratory that has the capability to perform mass spectroscopy, which rapidly and accurately identifies pathogens in patient samples, such as C. difficile.

"Following implementation of our antibiotic stewardship program, we observed a significant reduction in overall fluoroquinolone use, a category of antibiotics that has historically seen high rates of use," said Danielle F. Kunz, R.Ph., BCPS, antimicrobial stewardship pharmacist in UAB's Division of Infectious Diseases. "Plans are underway to expand the ASP to four affiliate hospitals."