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VA antibiotic use falls by 12% under national antimicrobial stewardship program

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February 3, 2017

Findings recently published in Infection Control and Hospital Epidemiology showed that the Veterans Health Administration’s systemwide antimicrobial stewardship program reduced inpatient antibiotic use by 12% from 2010 to 2015.

The initiative also cut down on the use of broad-spectrum antibiotics.

Antimicrobial stewardship programs (ASPs) strive to optimize antimicrobial use to avoid unintended consequences and improve clinical outcomes,” Allison A. Kelly, MD, MSOH, of the National Infectious Diseases Service of the Veterans Health Administration, Washington, DC, and colleagues wrote. “The Department of Veterans Affairs Veterans Health Administration recognized the importance of antimicrobial stewardship programs and began the VHA Antimicrobial Stewardship Initiative in mid-2010 with the goal of providing national guidance and resources for the implementation of ASPs at local VHA medical centers.”

The program’s implementation consisted of a series of guidelines and conferences, as well as online resources, provided by antimicrobial stewardship specialists. The researchers conducted a comprehensive survey of the program in 2012 with the aid of the VHA Healthcare Analysis and Informatics Group, then repeated it in December 2015 to analyze the progress and uptake of stewardship activities throughout the VHA health care system.

Antibiotic use began to fall as early as the second quarter of 2010, the researchers reported (P < .0001). From 2010 to 2015, antibiotic use overall fell by 12% from a high of 761.2 days of therapy per 1,000 inpatient bed days of care to 673.3 by the end of 2015. Kelly and colleagues reported no significant changes in the annual proportional distribution of different antibiotic agents or classes. Researchers also wrote that from 2012 to 2015, Clostridium difficile infection rates fell in VA hospitals.

A press release accompanying the study added that local facilities were encouraged to take an “a la carte” approach to implementing stewardship practices.

“One of the key findings of this report is that a ‘one-size-fits-all’ strategy to implementation of an antimicrobial stewardship program is not necessary to assure success,” Kelly said in the press release. “Leadership buy-in and support is critical to the success of any implementation program whether it be antimicrobial stewardship or other activities. However, leadership support is not enough. A cadre of committed professionals from multiple disciplines needs to be nurtured to bring expertise and passion for the safe use of antibiotics to help make such programs a success.” – by Andy Polhamus

Disclosure: The researchers report no relevant financial disclosures

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Keith Kaye
Keith Kaye

The results from this study demonstrate the usefulness and importance of antimicrobial stewardship initiatives. In just 5 years, the Veterans Health Administration decreased the use of broad-spectrum antibiotics within more than 140 medical facilities — a huge feat. There were a number of reasons that the VA saw so much success with its program. The VA had leadership buy-in and support from hospital professionals that added expertise and a strong desire to see the program succeed. Additionally, the local VA medical facilities were able to adapt the program to their specific needs, which allowed for seamless implementation and continued support among leadership and other facility professionals. A key takeaway from this study is that antimicrobial stewardship programs can be very successful, as long as there is leadership support and the ability to adapt the program to a facility’s individual needs.

Keith S. Kaye, MD, MPH

Infectious Disease News Editorial Board member

Professor of internal medicine

Director of clinical research, division of infectious diseases

University of Michigan Medical School

Disclosure: Kaye reports no relevant financial disclosures.