Antibiotic Resistance At St. Clair Hospital Is A Matter Of Patient Health And Safety

Antibiotics, or antibacterials, are one of our strongest tools in treating and preventing bacterial infections. Unfortunately, these miracle drugs are in trouble. Bacteria are outsmarting antibiotics by developing resistance to them. As a result, some antibiotics are no longer effective in treating bacterial infections. Instead of dying, the bacteria grow, multiply and spread, and the infection becomes worse.

Antibiotic-resistant bacteria are tough to eradicate and costly to treat, and they are a significant cause of death across the globe. All over the world, governments and public health agencies including the World Health Organization are scrambling to find solutions. In the U.S., more than 2 million Americans acquire antibiotic-resistant infections every year, and at least 23,000 die as a result, according to a Centers for Disease Control and Prevention (CDC) report.

Antibiotic resistance is one of the most serious, fastest growing and most dangerous public health problems in the world. At St. Clair Hospital, our staff is very aware of this problem – and we are developing ways to ensure our patients receive the best care in spite of it.

Addressing Antibiotic Resistance At St. Clair Hospital

Antibiotic resistance is being met head-on at St. Clair by an exemplary SWAT-like multidisciplinary medical team: the Antibiotic Stewardship Team. These physicians, microbiologists, nurses and pharmacists bring together experience, top-notch skills and a collaborative spirit that melds their diverse capabilities into a cohesive army focused entirely on addressing the danger of antibiotic resistance.

St. Clair Hospital initiated the Antibiotic Stewardship Team four years ago, well ahead of most hospitals. “At St. Clair, we created the Antibiotic Stewardship Team because it was the right thing to do,” according to Laura A. Morris, M.T. (ASCP), CIC, Senior Infection Preventionist at St. Clair and one of the leaders of the Hospital’s Antibiotic Stewardship Team. “It’s another way to assure that our patients are getting the best care possible.”

The team is a dynamic and highly organized group whose mission is to improve every aspect of antibiotic use within the Hospital. To achieve that, they have created processes, policies and practices that monitor and manage all patterns of infection, antibiotic use and resistance. In addition to closely following every patient who is given antibiotics, the Antibiotic Stewardship Team issues regular reports to all clinical staff; compiles an annual “antibio-gram” report to the CDC; collaborates with other health care providers in the region; and provides continuing education to keep clinical staff up-to-date on emerging developments.

And when any bacterial infection is suspected in our hospital, the team is alerted and their meticulous systems are set in motion.

Evidence-based Practices Guide Antibiotic Use

The process of monitoring and managing antibiotic use is a complex one, with many essential and very precise steps. Like so many clinical endeavors at St. Clair, the system used to address the dangers of antibiotic resistance is a true team effort, involving many departments and individuals, from St. Clair’s ER, to its labs, to its specialized Antibiotic Stewardship Team. In complex cases, the Infectious Diseases Department may be consulted as well.

Most importantly, however, the process is a path to wellness for the patient, with constant, ongoing assessment and adjustments, a constant fine-tuning in order to provide the highest quality care.

Amanda M. Michael, D.O., a bacteriologist and board-certified Infectious Disease physician specialist, is the Medical Director of the Antibiotic Stewardship Team. She describes the process of determining the use of antibiotics as a balancing act. “It takes a huge effort behind the scenes to treat people as needed, but without misusing antibiotics. The goal is to get the patient started on the right antibiotic, as soon as possible, for the shortest duration, using the narrowest spectrum possible,” she explains. “We never take the administration of antibiotics lightly; there is a significant downside to getting antibiotics that you do not need.”

According to the CDC, 50 percent of all antibiotics prescribed in the U.S. are not necessary or are inappropriate for the infection being treated. This misuse leads to “superbugs” — multidrug resistant organisms, like MRSA (methicillin-resistant Staphylococcus aureus) — that resist many classes of antibiotics. The consequence, says Dr. Michael, is that illnesses that were once easily treatable are far more challenging. Worse, in some situations, there are no longer any options for treatment.

“It can be frightening when we don’t have the appropriate weapons in our arsenal, but it’s a rare occasion when we have no options at all,” she says. “More often, giving an antibiotic is like a puzzle — we try to match the right antibiotic to the infection.”

Outsmarting ‘Smart’ Bacteria is an Ongoing Challenge

Bacteria become resistant to an antibiotic when they evolve in a way that protects them from the drug. The development of antibiotic resistance is normal; all living organisms fight to preserve their lives and multiply. But what is different today is the way that antibiotics are being used. Overuse promotes resistance, as does misuse, such as prescribing an antibiotic to treat a viral infection. And every time bacteria outsmart an antibiotic, treatment options grow more limited, infections are prolonged, suffering is worse and costs are higher.

St. Clair Hospital’s new process allows us to reduce these effects of improper antibiotic use. Amy Georgulis, Pharm. D., a Clinical Pharmacist Specialist, is one of several Hospital pharmacists who serve on the Stewardship Team. She explains that, “We have always treated infections, and we will continue to treat infections, but now we try to do so in ways that will reduce side effects and minimize the development of superbugs. Sometimes, this means stopping the antibiotic a little earlier than the usual 10-14 days. A shorter duration, of five days perhaps, will sometimes do the job.”

And while antibiotic resistance is scary to talk about, Amy is quick to point out that there are still effective and safe antibiotics available. “The situation is concerning because more bacteria are showing up resistant, nationwide, but we do have antibiotics that work.”

And the task of addressing this reality doesn’t stop when an illness is cured, either. “At St. Clair, we educate our patients and their families about taking antibiotics appropriately,” says Laura. “We look at the big picture: the Hospital plus the community, including nursing homes and other hospitals. We share patients, so we must work together. We also do a lot of outreach, sending our infectious diseases physicians to these other facilities. It’s not a single-hospital issue, it’s a community one, and it’s a challenge. But at St. Clair we are very much on top of the problem of antibiotic resistance. St. Clair Hospital is always driven by quality, and that is what drives the Antibiotic Stewardship Team.”

This story is an edited version of a full report recently published in our Winter 2017 edition of HouseCall. If you want to read the full write-up – which includes more information about the in-depth antibiotic use process our departments utilize on a daily basis, as well as about exactly how bacteria develop resistance – you can visit our website and download a copy of our Winter 2017 HouseCall here.