6th Edition In-Depth: The Importance of Antibiotic Stewardship

The World Health Organization (WHO) announced the beginning of the “post-antibiotic” era in April of 2014 and declared antimicrobial resistance a global health issue.  The US Centers for Disease Control and Prevention (CDC) reports that each year in the US approximately 2 million people develop an infection that is resistant to antibiotics, and about 23,000 of these people die as a result of the infection. 

A project commissioned by the British government, entitled The Review on Antimicrobial Resistance, released a report identifying an estimated 50,000 deaths annually in the US and Europe are linked to antibiotic resistance and the worldwide estimate of deaths each year due to antibiotic resistance at  around 700,000.

For those who have not experienced the danger of antibiotic resistance, the problem may not seem alarming. However, resistance to antibiotics will eventually lead to limitations in medical treatment options because of bacteria that cannot be managed or killed by available antibiotics. For example, the safety of surgical procedures may be threatened due to the increasing resistance to antibiotics, and patients who are immunocompromised from chemotherapy may experience life-threatening complications from super bugs that have become resistant to antibiotics.   

Joint Commission International (JCI) continually strives to identify trends in health care to ensure our standards help organizations provide safer patient care. One of several new standards developed for the JCI Accreditation Standards for Hospitals, 6th Edition addresses the issue associated with antimicrobial resistance. This new standard, MMU.1.1, requires organizations to develop and implement a program for antibiotic stewardship. 

MMU.1.1 requires the program for antibiotic stewardship to involve infection prevention and control professionals as well as physicians, nurses, pharmacists, trainees, patients, and families. Patients and families are included as part of the program to ensure they understand the importance of compliance with antibiotic treatment. 

Included as part of the program is the need for proper use of antibiotics for prophylaxis in addition to properly prescribing antibiotics for infections. The standard also requires the hospital to have a mechanism for oversight that may include reporting to the pharmacy and therapeutics committee, a small work group, a task force, or some other mechanism to oversee the program and track the effectiveness of measures to improve the proper use of antibiotics.  

Monitoring the effectiveness of the antibiotic stewardship program is important for identifying the success of the program. Examples of the effectiveness of the program may include an increase in compliance with stopping prophylactic antibiotics on time or a decrease in the inappropriate use of broad spectrum antibiotics.

Implementing an antibiotic stewardship program takes time and resources. It may be helpful to start small and expand slowly. It is important to use data to guide the development and expansion of the program when possible. In order to gain hospital-wide acceptance and increase success for the program, formal implementation is recommended as well as leadership support for staffing, technical, and financial resources.