HCA Midwest Health - December 16, 2019

As we frequently see in the news, antibiotic resistant superbugs have the potential to impact every person around the world. The World Health Organization predicts that by 2050, antibiotic resistant infections will be the main cause of death worldwide, surpassing cancer, heart disease and diabetes.

Surgeries, cancer therapies and treatment of chronic conditions all depend on the ability of antibiotics to fight infections, so it’s critical that we all work together to reduce the impact of antibiotic resistance. Without effective antibiotics, we could very well return to the days when a small cut could become life-threatening.

Penicillin was first used to treat patients in 1942. Since then researchers have discovered more than 100 different antibiotics, but that is not enough. Drug resistant microbes evolve into new species incredibly fast. For example, E. coli can reproduce every 20 minutes, acquiring new characteristics that allow it to become resistant to drugs. According to research, it only takes about a year for the first resistant microbes of a new drug to emerge.

Antibiotic resistant infections can lead to extended hospital stays, more doctor visits and dire consequences. The Centers for Disease Control and Prevention (CDC) estimate that in the United States about 2.8 million people a year become sick with antibiotic resistant infections and for about 35,000 people, it is fatal. Fortunately, according to the latest (2019) Antibiotic Resistance Threats in the United States report, the number of deaths from superbugs has dropped by 18 percent since the 2013 report. Increasing awareness and improved practices in the medical community and the public have all contributed to this decrease, but the number of people who are infected and die is still too high.

Antibiotics are effective against bacterial infections, but if they are taken improperly or used when an infection is viral, they can speed up the development of antibiotic resistant strains.

“Any time antibiotics are used, they can lead to resistance. To help slow the development of superbugs, antibiotics should only be used when they are truly necessary and for as short of a time as possible,” states Kimberly Megow, MD, chief medical officer for HCA Healthcare MidAmerica Division.

A few years ago, an antimicrobial stewardship program was implemented at all HCA Healthcare hospitals across the country. The initiative is led by the hospital’s chief medical officer with the support of a multidisciplinary team of experts including pharmacists, doctors, lab staff, infectious disease physicians, and quality and infection prevention team members.

“Many times when a patient is admitted to the hospital they are given a broad spectrum antibiotic,” describes Dr. Megow. “Once the lab determines the specific type of bacteria causing the patient’s infection, many times they can be switched to narrow-spectrum antibiotic. These antibiotics are more targeted and are less likely to lead to antibiotic resistance.”

As part of the HCA Healthcare antimicrobial program, the hospital pharmacy pulls a daily report of all the patients who are on antibiotics. Each patient case is then reviewed to determine if the antibiotic is still necessary and appropriate. Many times a patient’s antibiotic can be deescalated. This means a patient can be switched to a narrow-spectrum medication or if the patient was taking more than one antibiotic the number may be reduced. If an opportunity to deescalate is identified, the pharmacist has a collaborative discussion with the attending physician to determine the best course of treatment.

“This program eliminates the inappropriate use of broad-spectrum antibiotics and results in improved patient care because we are able to appropriately address specific bacteria,” says Dr. Megow.

While antimicrobial stewardship programs have been successful at combating antibiotic resistance, the CDC stresses that the fight against the development and spread of these germs is everyone’s responsibility and that we must remain aggressive.

It’s important for patients to be educated about antibiotic overuse and misuse. They also need to be aware that a medication is not always necessary, and there are consequences to using antibiotics when not needed.

“Upon admission patients are provided with educational materials that discuss appropriate use of antibiotics and risks of inappropriate use,” says Dr. Megow.

In an outpatient or virtual setting, patients should take the time to prepare for a doctor’s appointment by carefully taking notes about their symptoms. This will help their physician determine if antibiotics are needed. If they are concerned about an antibiotic prescription they should ask questions and talk openly with their doctor.

“In a virtual setting where patients are more likely to see a different provider each visit, it’s important to have protocols in place to make sure antibiotics aren’t prescribed for recurring health issues,” states Dr. Megow.

HCA Midwest Health virtual doctors are trained to review a patient’s health records from previous video visits before starting a consultation. If the virtual physician or nurse practitioner sees that someone has been prescribed a medication too frequently or a condition is not being properly resolved, he or she will refund the cost and refer the patient to an in-person healthcare provider.

Making a difference, together

The CDC calls medication resistant superbugs one of the biggest public health challenges of our time. Both healthcare providers and patients have a responsibility to stop the rise of antibiotic resistant infections. Together, we can make a difference and save lives.

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