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    Antimicrobial stewardship programs aim to curb resistance problem

    The rise in the incidence of acute bacterial skin and skin structure infections (ABSSSI) of late has ushered in a new sense of urgency for health institutions across the United States to tackle the growing problem of antibiotic resistances head-on. Here, antimicrobial stewardship programs are largely viewed as one of the most important strategies for health authorities to more effectively address and hopefully quell the alarming trend of antibiotic resistance.

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    Formerly referred to as complicated skin and soft tissue infections that include infections with resistance to previously effective antimicrobial drug regimens, ABSSSI is a growing public health threat with far reaching implications including the burden of high direct and indirect costs to both the medical system and society.

    “Antimicrobial resistance is a challenging and increasingly alarming medical issue today, and a major concern for international organizations leading the way including the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC),” said Timothy R. Pasquale, PharmD, M.B.A., FIDSA, Manager, Clinical Pharmacy Services, Carolinas Medical Center, Carolinas Healthcare System, Charlotte, NC.

    “The use of antibiotics is the single most important factor leading to antimicrobial resistance. Although antimicrobial resistance is multifactorial, the implementation of antimicrobial stewardship programs could help combat the issue. The goals of antimicrobial stewardship include promoting the appropriate use of antimicrobials, improving clinical outcomes and helping reduce antimicrobial resistance,” he says.

    Antibiotics remain one of the greatest discoveries in modern medicine and according to Dr. Pasquale, antimicrobial stewardship programs could be one of the last resorts that medical authorities have to preserve their efficacy. Some of the main goals of such programs are to incorporate principles that address the appropriate utilization of antibiotics for all specialties and patient groups, which can differ from institution to institution.

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    Dr. Pasquale and his team of researchers recently conducted a single center, retrospective, observational chart review evaluating the impact of an antimicrobial stewardship program on the management of therapy and hospital resources for patients with ABSSSIs. Information, including patient demographic characteristics, comorbidities, ABSSSI subtype, antibiotic therapy, microbiology surgical interventions, and antimicrobial stewardship program recommendations, was collected from medical records and the antimicrobial stewardship program intervention log. Antimicrobial stewardship program recommendations were divided into five categories, namely, dosage changes, de-escalation, antibiotic regimen change, infectious diseases formal consultation, and other.

    For the 62 patients who were included in the study, a total of 85 recommendations were made to attending physicians with an acceptance rate of 95%. Results showed that the most common interventions included dosage changes, de-escalation, antibiotic regimen change, and infectious diseases consultation. These results were then compared with historical data for 1,149 patients with ABSSSI, and showed that the intervention group had a significantly lower mean length of hospital stay. It was also found that the 30-day all-cause readmission rate was significantly lower in the intervention group, but the 30-day ABSSSI readmission rate did not differ significantly between groups.

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