Antimicrobial Stewardship

Antibiotic stewardship is the coordinated effort to monitor and improve the antibiotic prescribing practices of healthcare providers and antibiotic utilization of patients. Antibiotic stewardship aims to ensure that the right drug, dose, and duration are selected appropriately when an antibiotic is advised. Stewardship also minimizes misdiagnoses or delayed diagnoses leading to underuse of antibiotics.

 

Public Health Significance

Antibiotic resistance is an emerging global public health threat, recognized by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). The 2019 CDC Antibiotics Resistance Threats Report estimated that more than 3 million antimicrobial resistant or Clostridioides difficile infections occur in the United States each year, and more than 50,000 people die as a result.1 Antimicrobial resistance was identified as a leading cause of death around the world, with the greatest burden in resource-limited countries.2,3

Similar to global trends, antimicrobial resistance is on the rise in Hawaiʻi. In comparison to 2022, the Hawaii Department of Health observed a 54.2% increase in Carbapenemase-producing organisms (CPO) detected in 2023 from Carbapenem-resistant organisms (CRO) clinical isolates sent to Hawaii SLD (24 detected in 2022 vs 37 detected in 2023).4

 

Hawaiʻi Antimicrobial Stewardship Programs

  1. Hawaiʻi Antimicrobial Stewardship Collaborative (HASC) for Acute Care Hospitals: convenes Acute Care Hospitals virtually to exchange ideas, to support efforts to improve antibiotic prescribing, as well as to stay informed about current recommendations and best practices.
  2. Hawaiʻi Antimicrobial Stewardship Collaborative (HASC) for Long Term Care Facilities (LTCF): convenes regularly to support efforts in implementing effective antimicrobial stewardship programs in long-term care facilities.
  3. National Healthcare Safety Network (NHSN) Antimicrobial Use and Resistance (AUR) Module monitoring | CDC AUR Chapter 14: regular data quality checks of AUR data may be submitted to facilities and technical assistance regarding the AUR module can be provided. The Targeted Assessment for Antimicrobial Stewardship (TAS) was developed to use NHSN AU Option data for action and can be implemented at participating facilities.
  4. Public Medicare Part D Data for Outpatient Antibiotic Prescribing Feedback Letters and Survey: Medicare Part D data from 2021 was analyzed to identify family practice and internal medicine physicians in the 90th percentile of antibiotic prescribing by volume among Medicare Part D beneficiaries in Hawaiʻi.

 

References

  1. globe iconCenters for Disease Control and Prevention. (2023, September 7). Core Elements of Antibiotic Stewardship. [Sanchez, G.V., Fleming-Dutra, K.E., Roberts, R.M., Hicks, L.A. Core Elements of Outpatient Antibiotic Stewardship. MMWR Recomm Rep 2016;65(No. RR-6):1–12.]
  2. globe icon Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.
  3. globe icon Murray, C. et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis, The Lancet, Volume 399, Issue 10325, 2022, Pages 629-655, ISSN 0140-6736.
  4. globe icon COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022.
  5. globe icon Hawaii State Department of Health Disease Outbreak Control Division Antibiotic Resistance (AR) Surveillance 2023 Annual Report.