UC Davis experts help community hospitals to develop programs that reduce antibiotic overuse and still protect patients.
Once perceived by the public as a magic cure-all for a wide variety of minor infections — and by physicians as a smart hedge against infection in inpatients — antibiotics are now commonly paired with the word “crisis” because of growing evidence that overuse is dangerously reducing their effectiveness.
The specter of “antibiotic resistance” is especially problematic at hospitals and other inpatient facilities, where immunocompromised patients are among the very people who need the drugs’ protections the most. Yet at the same time, the Centers for Disease Control and Prevention estimates that 20 to 50 percent of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate.
It’s enough of a worry that in 2014, California became the first state to mandate antibiotic stewardship programs for medical centers. And specialists from UC Davis’ Division of Infectious Diseases are now helping several community hospitals around the region to meet the new requirements, collaborating on both individual cases and structural arrangements to help maximize safety for immune-weakened patients without contributing to the overall resistance problem.
“We try to act as helpful, professional guides and help to offer decision-makers a high level of up-to-date expertise, just as we do in our internal stewardship efforts here at UC Davis Medical Center,” said Stuart Cohen, M.D., chief of the Division of Infectious Diseases at UC Davis Health and its director of Hospital Epidemiology and Infection Control. Cohen was first author of the last set of Clostridium difficile infection guidelines issued by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America.
“By virtue of our role we can offer an academic perspective on how these things work, and we’re highly linked into academic and professional infection-control communities so that we can provide the resulting knowledge base to our partners.”
Cohen and colleague Jennifer Brown, M.D., are the division’s point physicians helping hospitals tackle the new state requirements, which result from California Senate Bills 1311 and 739. The laws require general acute care hospitals to design, adopt and implement antimicrobial stewardship policies in accordance with federal and professional guidelines, and also to develop a physician-supervised multidisciplinary antimicrobial stewardship working group (with at least one physician or pharmacist knowledgeable about stewardship through prior training or continuing education).
At Barton Memorial Hospital in South Lake Tahoe, an existing two-decades old relationship with Cohen has now evolved into a full antimicrobial stewardship program. He sits on the hospital’s stewardship committee and helps to make decisions about the facility’s formulary and antimicrobial use, and also meets monthly with Barton’s infection preventionist and nursing leaders to review cases and consult on interventions. Cohen also conducts outpatient and inpatient consultations via telemedicine, telephone and even text message.
In a less-formal partnership arrangement, Cohen or Brown also meet monthly with the antimicrobial stewardship team and pharmacists at the Adventist Health Lodi Memorial Medical Center.
“We match a local hospital’s needs and can meet whatever level of need they want, up to full consultation,” Cohen said. “And we can do it all through telemedicine.”
In a budding relationship with Ridgecrest Regional Hospital in the southeast Sierras, Cohen has consulted on diagnostic testing and other issues and is slated to review the hospital’s antibiogram. The profile of antimicrobial susceptibility testing results serves as a road map for the facility’s antibiotic formularies and treatment pathways, and can help to identify resistance trends.
“The involvement has been very well accepted by our medical staff,” said Ridgecrest’s CEO Jim Suver. “Even though we do have an infectious disease physician on staff, the extra resources that Dr. Cohen can bring are really going to enhance care and help with stewardship, due to that academic linkage.”