Debating the Value of Incorporating Antibiotic Stewardship Principles Into Infection Guidelines

Oyin Abu,Yetunde ;

Debating the Value of Incorporating Antibiotic Stewardship Principles Into Infection Guidelines

January 20, 2025

By Yetunde Oyin Abu, PharmD

News

Article

ContagionContagion, Winter 2024 Digital Edition

Volume 9

Issue 04

Significant value can be offered through the incorporation of stewardship concepts into infection guidelines, but we must also address the risk and challenges it may impose on health care systems.

Over the years, we have seen the emergence of antibiotic resistance become a major global health concern. When compared against high mortality rates that occur annually from cancer (8.2 million) or diabetes (1.5 million), we see antibiotic-resistant infections account for approximately 700,000 deaths each year (FIGURE).¹ It is estimated that the number of deaths resulting from antibiotic resistance will reach 10 million annually by 2050.¹

As health care facilities experience increased rates of bacterial infections, it has become evident that action must be taken against the misuse of antibiotics in hopes of reducing mortality rates in future generations. In November 2015, the Centers for Disease Control and Prevention (CDC) requested guidance from the Healthcare Infection Control Practices Advisory Committee to assist in helping professional organizations incorporate antibiotic stewardship principles into treatment guidelines.² Through the development of clinical guidelines and implementation of antimicrobial stewardship programs, hospitals in various settings have been able to combat antibiotic resistance using strategies that ensure proper antibiotic selection, improve clinical outcomes, and promote evidence-based practices.

Clinical practice guidelines are a key antimicrobial stewardship strategy and play an important role in supporting appropriate antibiotic prescribing.³ By integrating stewardship principles into infection guidelines, we enhance the quality and consistency of our recommendations. It encourages our clinicians to accurately select the antibiotic of choice based on indication of treatment, local resistance patterns, and accounting for patient allergies. This selective approach tailors a patient’s course of treatment to the specific pathogen cultured. The risk for adverse reactions diminishes, as the incorporated stewardship principles provide a clear recommendation on appropriate duration of therapy. Optimal clinical outcomes are achieved when clinicians follow the Five Rights of Medication Safety: the right drug, at the right dose, for the right duration, at the right time, and for the right patient,” when prescribing antibiotics.⁴There are several key components within antimicrobial stewardship that build the overall framework of infection management. The first benefit seen is with the creation of antimicrobial stewardship programs and how each principle has played a significant role in contributing to cost-effective savings. This is evident through minimizing inappropriate antibiotic use, reducing treatment costs (often associated with prolonged hospital stays), and actively performing clinical interventions. ⁴ The economic burden that has resulted from antibiotic resistance on health care systems be prevented when we optimize antibiotic therapy. Other aspects to consider are our efforts as providers to morally boost the quality of health care as a whole for our patient population. How are we able to do this? It is done by highlighting the use of evidence-based practices and placing a primary focus on patient-centered care. By doing so, we can build trust into our health care systems and improve patient satisfaction.⁴ Patient engagement can also prove to be beneficial in debating the value of stewardship concepts being integrated into guidelines. Providers who take the time to involve their patients in their own care enhance the effectiveness of stewardship efforts.⁵They are given the opportunity to take an active role in their treatment, which opens up clear communication between provider and patient when discussing whether treatment with antibiotics is necessary. In current practice, we are beginning to see an increase in treatment of viral infections with antibiotics, and a lack of patient education to question whether antibiotics are necessary is leading to more antibiotic misuse.⁶ When we educate our patients, we empower their understanding of the role they have in antibiotic stewardship.⁵ Patients are less likely to request antibiotics for infections that usually require rest, use of over-thecounter medications, or hydration.⁶ The disconnect can be cleared if we teach our patients to differentiate between bacterial and viral infections while stressing the importance of conserving antibiotics for bacterial infections only.

As health care providers, our duty lies not only at a clinical level but also in helping to safeguard our communities. The integration of stewardship into infection guidelines globally aligns with public health initiatives.⁷This is seen in our initiative to combat resistance through promoting awareness, while utilizing preventative measures to protect patient population. We have seen positive impacts in other aspects of pharmacy, such as population health through the mitigation of risks commonly associated with bacteria-resistant infections.⁷ The antimicrobial resistance (AMR) global health issue can be tackled by encouraging clinicians to take a multidisciplinary approach. In most health care settings, these teams usually include a physician, pharmacist, nurse, or infection control specialist.

Through communication and teamwork, clinicians can optimize treatment plans, gain a holistic understanding on their patient’s needs, and foster a culture that values collaboration and shared decision-making. At a glance, the intertwining of stewardship concepts into infection guidelines appears to be perfectly packaged and filled with great promise. However, there are two sides to a debate, and we must address the challenges imposed on health care facilities. For example, health care providers may exhibit hesitation toward accepting implementation of newer stewardship principles. This could be due to the fact that clinicians are accustomed to traditional practices and resist straying from older foundations.⁸

A way of facilitating this cultural shift is to provide training and education through in-house services to help clinicians understand the benefits of adopting these principles into their daily patient care.⁸ Limitations in resource access is another challenging barrier. These restrictions can stem from unreliable access to antimicrobial prescribing trends, lack of financial infrastructure, unsurety in acquiring quality-assured antibiotics, or knowledge deficits regarding optimal use of antibiotics.⁴Regardless of 31 setting, there are facilities that experience resource constraints that can hinder a clinician’s ability to safely provide care for patients or safely implement an antimicrobial stewardship program. To ensure the success of integrating stewardship principles into evidence-based guidelines, all clinicians, irrespective of practice setting, must be equipped with the necessary tools and support system.

As the area of infectious diseases continues to advance through the emergence of new pathogens, it will be important to ensure that infection guidelines stay up to date, thereby equipping our providers with the latest evidence-based practices. Clinicians, however, will need to adopt newer strategies, which may shift their practices to focusing on resistance patterns, investing more time into the research of antimicrobial stewardship, and learning optimal treatment strategies to sustain infection guidelines.

Ultimately, there is value in incorporating stewardship concepts into infection guidelines. This has been shown through the enhancement of patient care and the combating of antibiotic resistance.³ An antibiotic stewardship program that incorporates the CDC Core Elements of Antibiotic Stewardship as appropriate for the type of infection and treatment setting should be cited within guidelines as a valued resource for determining antibiotic selection.²Clinicians can properly manage infections through the possession of tools and resources, while safeguarding the efficacy of antibiotics for future generations. It will be vital for clinicians to embrace stewardship concepts as health care evolves, as these concepts will be essential in navigating the complexities of infection management.