What happens when there are no antibiotics left that work?
For researchers and healthcare organisations world-wide, it is a question that is becoming all too real as global antimicrobial resistance continues to rise.
Tuberculosis, HIV, shigella, e coli, vancomycin-resistant enterococci and Stapyloloccus aureus are all examples of drug resistant bacteria that are posing problems across Australia and New Zealand. Indeed, multidrug-resistant organisms (MDROs) are increasing morbidity/mortality and costs across the healthcare system.
The challenge now? How to change the status quo in order to combat resistance.
Creating change at scale
According to the World Health Organisation (WHO), “single, isolated interventions have limited impact on antimicrobial resistance. Instead, the WHO recommends “coordinated action” in the form of “national plans.”
In part, that means ensuring that the right drugs are reaching the right patients – and at the right time, for the right duration. Indeed, inappropriate and unnecessary prescribing is one of the most significant contributors to antimicrobial resistance.
According to an Australian report on antimicrobial use and resistance in human health, in 2015 over 23 percent of prescribing in hospitals didn’t meet guidelines and 21 percent were identified as being inappropriate.
In New Zealand, the use of antimicrobials is estimated to have increased by as much as 49 percent between 2006 and 2014, indicating inappropriate prescribing practices and widespread use.
Antibiotics are often a go-to solution when they should be considered a last resort. The general public isn’t always aware of what illnesses antibiotics can effectively treat and see them as a catch-all cure to whatever ails them. Unfortunately, colds, cases of flu and runny noses can’t be helped by antibiotics. Using them for those purposes, however, helps fuel resistance and can have repercussions for both personal and public health down the line. Changing this perspective, however, is not so simple.
According to best practices, change can start within healthcare by:
- Focusing on effective prevention and control initiatives to stop the spread of infections
- Providing antibiotics appropriately and as-needed
- Developing an antimicrobial stewardship program and establishing benchmarks
- Engaging all staff in the goal of antimicrobial stewardship, from the nurse at the bedside to executives in the boardroom.
This year, the Australian Commission on Safety and Quality in Healthcare released the Antimicrobial Stewardship in Australian Health Care 2018 book, highlighting the urgency and severity of antimicrobial resistance. The book includes a list of suggested tools and strategies healthcare organizations can employ including:
- How to promote the uptake of national and local guidelines;
- Information about formularies and approval systems;
- Implementing post-prescription reviews and;
- Effective point-of-care interventions.
Beyond that, however, the guide highlights the complexity of stewardship and the importance of being prepared with the right tools to support programs and initiatives. This is where technology has a role to play in helping to provide timely and relevant information, critical decision support and surveillance.
According to the guide, electronic surveillance and infection prevention systems can support stewardship in a variety of ways by:
- “Direct antimicrobial choice based on microbiology results
- Identify opportunities for de-escalation
- Improve antimicrobial dosing and monitoring
- Shorten clinical response time
- Contribute to broader quality improvement issues.”
However, technology is only as good as the initiatives and teams using it. Though the question and challenge of drug-resistant bacteria remain, increased focus on the value and urgency of stewardship initiatives has shone a light on the importance of conservation and the role that everyone in healthcare – patient and provider – plays in it.