July 02, 2019
2 min read

‘Unexpected’: Centers following CDC framework use more of certain antibiotics

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Study results suggest that hospitals meeting all seven of the CDC’s Core Elements of Antimicrobial Stewardship Programs use more broad-spectrum antibiotics for community-acquired infections and anti-MRSA agents compared with hospitals that do not meet all of the core elements — a study finding that researchers called “unexpected.”

Developed by the CDC, the Core Elements of Antimicrobial Stewardship Programs detail recommendations for inpatient antimicrobial stewardship programs.

“These elements include (1) leadership, (2) accountability, (3) drug expertise, (4) tracking, (5) actions (6) reporting, (7) education,” Shaina R. Bernard, PharmD, antimicrobial resistance coordinator with the Virginia Department of Health, and colleagues wrote.

In their study, the researchers sought to determine if meeting all core elements was associated with less use of antibacterial agents.

In April 2016, they sent a survey to antimicrobial stewardship program (ASP) members, with a follow-up sent in May 2016. The researchers assessed antibacterial use by compiling data from the Vizient clinical database resource manager, which included charge-based inpatient medication, procedure and diagnosis information from the surveyed hospitals.

Of 211 hospitals that responded to the survey, 57 had relevant data in the clinical database. Of those 57, 47% (n = 27) met all seven core elements. The other 53% (n = 30) met three to six elements, of which 60% met six, 27% met five, 6.6% met four and 6.6% met three. Among these same 30 hospitals, 100% met the actions element, 96% met the drug expertise element, 95% met the accountability element, 93% met the tracking element, 93% met the education element, 77% met the reporting element and 61% met the leadership element.

Bernard and colleagues report observing statistically significant differences in use of anti-MRSA and broad-spectrum community-acquired infection agents between the hospitals that met all seven core elements and those that did not. Specifically, the researchers found that hospitals meeting all seven core elements were associated with greater use of anti-MRSA and broad-spectrum community-acquired infection agents.

“These findings were unexpected because we hypothesized that fewer antibacterial agents would be used in hospitals that employed all elements,” Bernard and colleagues wrote. “It is possible that hospitals that adopted all elements had a greater need for a more robust ASP due to a higher baseline rate of antibacterial use.”

The researchers suggested that more research is needed, specifically investigating meeting individual core elements and its impact on ASP outcomes.

“For example, for the reporting element, what types of data need to be reported, in what manner, and how often, to impact on desired program benefits? Ultimately, identification of element components that lead to decreased antibiotic resistance is an important goal in this line of inquiry,” they concluded. – by Marley Ghizzone

Disclosures: The authors report no relevant financial disclosures.