Antibiotic stewardship programs in small hospitals often lack ID expertise
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While most U.S. hospitals have an antibiotic stewardship program, many smaller hospitals lack infectious disease expertise on their stewardship teams, and only about half of all hospitals use frontline workers in their programs, a nationwide survey showed.
“There have been a lot of recommendations about how stewardship should be done and who should be involved, but there have been fewer studies looking at who actually is involved in stewardship,” Valerie M. Vaughn, MD, MSc, an assistant professor of medicine at the University of Michigan Medical School, told Healio. “We know that stewardship works best when there is collaboration across multiple disciplines, so we really wanted to know whether that collaboration was happening.”
Vaughn and colleagues sent surveys to infection preventionists at 900 randomly sampled U.S. hospitals between May and October 2017. According to the study, the survey collected data on antibiotic stewardship programs; Clostridioides difficile infection prevention, treatment and testing practices; and diagnostic stewardship strategies.
In total, 528 hospitals responded, with 95% of them reporting an antibiotic stewardship program.
“However, these teams may not include all the expertise we’d hoped,” Vaughn said.
For example, 52% of all programs had an ID-trained pharmacist and 69% had an ID physician, and only 43% had both. In hospitals with fewer than 50 beds, 41% of programs included either an ID pharmacist or ID physician, and only 11% had both.
“Though we didn't assess this directly, this is likely because small hospitals don't have ID experts at their institutions. There's a shortage nationwide of ID physicians and trained ID pharmacists,” Vaughn said.
The responses showed that only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary stewardship teams — an ID physician, an infection preventionist, a pharmacist and another non-defined practitioner. Vaughn said hospitals are not being penalized for not meeting this benchmark, which is required only “when available.”
Vaughn said there is “definitely room for improvement” in engaging frontline providers, noting that only about half of stewardship programs included hospitalists or nurses. Responses showed that guideline-recommended practices for preventing C. difficile were common, but that smaller hospitals “were less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies.”
“I'd love to see antibiotic stewardship really continue to work to engage frontline clinicians — whether that be nurses or hospitalists or other physicians,” Vaughn said. “Engaging clinicians in stewardship can only improve antibiotic use and outcomes. Furthermore, diagnostic stewardship is also a key area for improving antibiotic use — and one that even small hospitals may be able to implement.” – by Caitlyn Stulpin
Disclosures: Vaughn reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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