When Geneen Gibson, PharmD, started her job at Savannah’s St. Joseph’s/Candler Health System in January 2008, doctors and pharmacists were already nervous. Some of the infections that brought many patients to the hospital were no longer responding to standard drugs that doctors used to fight them.
|Bacteria like Methicillin-resistant Staphylococcus aureus (MRSA) cause dangerous, difficult-to-treat infections, a consequence of antibiotic resistance.|
“We were really concerned,” said Gibson, infectious disease pharmacy specialist at the hospital. “Our doctors were seeing all these patients with infections that were becoming increasingly difficult to treat.”
If antibiotics continued to lose their potency, the hospital staff knew it wouldn’t be too long before strains of drug-resistant bacteria spread across the city of Savannah, including to St. Joseph’s main competitor, Memorial University Medical Center (MUMC).
So a team led by Nenad Avramovski, M.D., an infectious disease specialist at St. Joseph’s/Candler Health System, began drumming up support for a way to protect Savannah’s patients by limiting the emergence of these drug-resistant germs. In January 2012, they launched a citywide antimicrobial management program, designed to help doctors, pharmacists and other care providers in the city’s busiest hospitals to become more vigilant in prescribing the drugs.
“We are really trying to change the way they think about prescribing antibiotics,” Gibson said.
The Savannah program is a small skirmish in the emerging war against antibiotic resistance, a major public health problem threatening patients in health care facilities all over the world. According to the Centers for Disease Control and Prevention, more than 2 million Americans become infected with drug-resistant bacteria each year, and 23,000 die from their disease.
Experts say years of profligate use of antibiotics in hospitals, doctors’ offices and homes have allowed bacteria to learn to fend off the drugs.
“We now have diseases that we can no longer treat with antibiotics,” said Jeanne Negley, who leads antimicrobial stewardship efforts at the Georgia Department of Public Health. “We need to act now to address the rising resistance of bacteria.”
Typically, when a patient develops an infection, doctors will begin treating them with a broad-spectrum antibiotic -- one that targets a wide range of bacteria – until lab tests can identify the specific type of germ that’s making the patient sick.
When that diagnosis comes, doctors can switch to a narrower antibiotic, one that targets only the problem bacteria. But when doctors don’t make the switch, bacteria throughout the body are exposed to the drug that’s designed to kill them – and they can learn how to fight back.
Doctors in Savannah’s citywide antimicrobial management program don’t want to give bacteria that fighting chance. In the program, a committee of doctors and pharmacists meets each month to talk about trends of resistance and antibiotic use in the city. One of the six infectious disease specialists at the city’s three major hospitals – St. Joseph’s, Candler and MUMC – is on call each week, evaluating specific antibiotics and every adult patient who is receiving them. Based on the specifics of the patient’s condition, the doctors will make recommendations to the physician coordinating care to stop antibiotics or switch to a drug with a narrower scope.
Gibson notes that the recommendations are just that, and doctors don’t have to take their advice. At first, about 50 percent of the recommendations made by the antibiotic committee were taken by physicians. After two years, the number is up to 75 percent.
“We give them advice, we don’t try to tell them what to do,” Gibson said, “We try to make it a very collegial interaction. The important thing is to start a dialogue about the use of these drugs.”
The program is also expanding the number of antibiotics it’s keeping an eye on. At first, the group focused on five of what Jason Lin, clinical pharmacist in infectious disease at MUMC, calls “big-gun antibiotics.” Now, doctors in the program keep tabs on 16 different drugs.
Lin said the program has fostered a great sense of stewardship at MUMC when it comes to using powerful antibiotics.
“If the patient doesn’t need this broad-spectrum antibiotic that could drive resistance, we need to not use it. That point has been well-taken in our hospital,” he said.
Besides a change in attitudes, the program is making other noticeable differences. Gibson said the decreased use of antibiotics in St. Joseph and Candler hospitals have saved $500,000 in the health system’s pharmacy budget. Lin reported a similar savings for MUMC’s pharmacy. Although two years is too short a time to measure the impact of prescribing practices on bacterial resistance, Gibson said early signs on that front are positive as well.
“We are starting to see reduced trends in our bacterial resistance,” she said.
Both Gibson and Lin say the program works in Savannah because the city’s relatively small size makes it possible for its major hospitals to work together. Larger cities with multiple health care systems may find it more challenging to recreate the program. But Negley said it takes more than one hospital to fight antibiotic resistance in a community.
“Patients are shared among health care facilities, and we need to address antibiotic-resistant disease with a regional approach,” she said. “The Savannah program is a remarkable, unique effort in Georgia and holds great promise to address this important public health threat in health care settings.”