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Antimicrobial stewardship: 'An unseen safety net'

An antimicrobial stewardship program, which began two years ago in Avera Queen of Peace in Mitchell, helps prevent the inappropriate use of antibiotics. (Photo courtesy of MetroCreative)1 / 2
An antimicrobial stewardship program, which began two years ago in Avera Queen of Peace in Mitchell, helps prevent the inappropriate use of antibiotics. (Photo courtesy of MetroCreative)2 / 2

A program at Avera Queen of Peace — that officials call "an unseen safety net" — is seeing success in preventing one deadly infection.

Two years ago, Avera Health started an antimicrobial stewardship program, which helps prevent the inappropriate use of antibiotics by monitoring dosage, duration of therapy and administration of the drug.

The program allows pharmacists within Avera's 33 hospitals to work with infectious disease professionals to request recommendations for local patients receiving antibiotics to improve therapy.

The program included Avera Queen of Peace in Mitchell, and now, more than two years later, the pharmacists and physicians have "embraced" the program, according to Brad Laible, an infectious disease trained pharmacist through Avera and a professor at South Dakota State University in Brookings. Approximately one-third of the 850 recommendations of the program coming from AQOP, he said.

And of those recommendations, almost 93 percent are accepted, meaning the physician agreed with the recommendation, Laible said, which is good news. Laible added that the Centers for Disease Control and Prevention estimates between 30 and 50 percent of antibiotic use is inappropriate. And with the new program, he hopes this will change.

"It's inappropriate in some way. Meaning either it's not the antibiotic, they don't need an antibiotic or might be other things like the dose wasn't correct or duration wasn't proper," Laible said.

With this large percentage, Laible said, there's an increasing need to do more for prescribers, and the antimicrobial stewardship teams is one way to approach the issue.

And since the start of the program in Mitchell, lead pharmacist at AQOP, Jamie Grosdidier, has noticed a decrease in Clostridium Difficile — a severe infection caused by antibiotics that has a "very high" mortality rate.

Clostridium Difficile, often called C. Diff, is most likely found in patients who've gotten antibiotics and more than 29,000 people die from the infection each year. It can be spread from patient to patient, and is not easily eradicated from facilities, Grosdidier said.

But in Mitchell, fewer rates of C. Diff have been found and this shows signs of "appropriate antimicrobial use." And Grosdidier said it's all thanks to the program, adding that it's a testament to the physicians and providers on staff.

"We're a small local community and I think our physicians really are dedicated to providing the best patient care they can to our patients here at Avera Queen of Peace," Grosdidier said. "I think that's part of benefit of being in a small community, and you frequently know of patients you're taking care of. I think our physicians really embrace that, and really do have the patient's best interest in mind."

'Behind the scenes'

The antimicrobial stewardship program is often never seen by patients, Laible said.

The "behind the scenes activity" allows pharmacists and doctor to collaborate on a plan for the patient. The physician then discusses the overall plan with a patient.

"It's kind of that unseen safety net if you will," Laible said. "And I think promoting awareness of that to the public is an important thing."

The focus of the program is to decrease inappropriate activity, both Laible and Grosdidier said, especially as the amount of antibiotic development is minimal.

"Our biggest concern is we just don't have a whole lot of new antibiotics being developed that we can start using when our old ones become ineffective," Grosdidier said. "We got to save the tools that are in our tooblox."

To avoid the creation of more resistant bacteria, Grosdidier urges patients to be compliant with antibiotics after being prescribed.

And in some cases, antibiotics are simply "not the right move," Laible said. He added that patients and consumers of antibiotics need to realize not every type of infection requires antibiotics.

"We need to be understanding and accepting of it when a physician tells us we don't need an antibiotic for an infection," Laible said. "Physicians are under a lot of pressure to prescribe antibiotics by their patients."