The researchers also believe that, as electronic health records become more sophisticated, there may be a way to implement an alert which could notify physicians that what they are prescribing may be redundant or duplicative. "Data shows that simply alerting the provider to the fact that they are about to prescribe two antibiotics that generally don't need to be used together can cause dramatic improvements," said Srinivasan.

Antimicrobial Stewardship Programs


Preventing potentially duplicative antibiotic therapy through Antibiotic Stewardship Programs (ASPs) is an increasingly common approach to providing cost savings and better patient outcomes. The researchers cite data from the University of Maryland which illustrates antibiotic costs diminishing with the use of an ASP. And when they stopped following the program, antibiotic costs began to rise again. Other research from the CDC has shown dramatically improved patient outcomes with ASP programs, with successful cure ratios in the 90th percentile, versus approximately 55 percent for non-ASP facilities.

Dr. Cosgrove said the relationship between health care acquired infections (HAIs) and ASPs is directly correlative. She and her team are working on a checklist to help hospitals ensure they are prescribing antibiotics responsibly.

There are currently no federal regulations requiring antimicrobial stewardship but California has been progressive in heading in that direction. "We've had antibiotics since the 1940s, and decade after decade doctors have been pleading for more careful use of antibiotics," said Cosgrove. "We have a problem with development of new antibiotics, particularly for gram negative antibiotics. We need to start doing something about it." Cosgrove said CMS currently requires an infection control program to be in place as a condition to receive reimbursement. She believes requiring an ASP program is a logical extension of that policy.

Assessing current adoption of ASPs

The researchers reported that there is very little data on the percentage of U.S. hospitals currently implementing ASP programs. According to surveys they send out to hospitals, 50 to 60 percent of the respondents classify themselves as having something they would describe as an ASP program. Those numbers may be misleading, however. "The response rate to the surveys is generally in the neighborhood of 20 to 30 percent," said Srinivasan, "We worry a little bit that folks who have ASPs are more likely to reply."

As electronic health records improve and the Affordable Care Act works to reshape the structure of care in the U.S., better practices with antibiotics are a logical space for improvement. Although it's hard to tell how many hospitals are actively using ASPs, they are increasingly showing interest in them. Cosgrove said she hopes the hospitals currently thinking about ASPs will soon be the ones that actually have one.

Back to HCB News

Infection Control Homepage