04:03am Thursday 19 October 2017

Responsible Stewardship by Clinicians is Critical to Preventing Antibiotic Resistance

Robert P. Gaynes, MD, associate professor of medicine (infectious diseases) at Emory University School of Medicine and a physician at the Atlanta Veterans Affairs Medical Center, wrote the editorial to accompany a paper in the same JAMA issue describing an outbreak of linezolid-resistant Staphylococcus aureus (LRSA) in an intensive care unit in Spain. Linezolid is used to treat a variety of bacteria, including methiciliin-resistant S aureus (MRSA).

Clinicians have not learned from previous issues with antibiotic resistance, and it is essential that they take the problem seriously, Gaynes says. For example, a strong association has been found between antibiotic use and the development of MRSA.

“As a drug class, antibiotics are virtually unique because once an antibiotic is released for wide-scale use, its efficacy diminishes,” Gaynes points out in the editorial. “Quality measures of antibiotic use are necessary and of critical importance. Increasing antibiotic resistance is a problem largely because of indiscriminate antibiotic use. Every clinician must do a better job to preserve the effectiveness of these essential therapies.”

The World Health Organization considers antibiotic resistance one of the three greatest threats to human health, and the Infectious Disease Society of America has called for a global commitment to develop new antibacterial drugs.

Controls over the use of antibiotics and responsible usage are known as “antibiotic stewardship,” and there are several reasons why this stewardship is critical, Gaynes says.

  • The supply of new antibiotics has dwindled, and pharmaceutical companies have curtailed or eliminated antibiotic drug discovery. Since 2008 the U.S. Food and Drug Administration has approved only one new antibacterial antibiotic – telavancin.
  • Antibiotic resistance is expensive in terms of both money and lives, causing longer hospital stays, more expensive treatments, and greater mortality.
  • Some antibiotic-resistant organisms may no longer have any treatment options.

Antibiotic stewardship is an urgent priority that must be fully integrated into quality improvement programs and should be designed to help clinicians select the best antibiotics to improve outcomes, Gaynes says. The careful management of antibiotics, including universal measures for appropriate use, benchmarks and national surveillance of antibiotic use are likely to be adopted in the near future.

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The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include the Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Yerkes National Primate Research Center; Winship Cancer Institute of Emory University; and Emory Healthcare, the largest, most comprehensive health system in Georgia. Emory Healthcare includes: The Emory Clinic, Emory-Children’s Center, Emory University Hospital, Emory University Hospital Midtown, Wesley Woods Center, and Emory University Orthopaedics & Spine Hospital.  The Woodruff Health Sciences Center has a $2.5 billion budget, 17,600 employees, 2,500 full-time and 1,500 affiliated faculty, 4,700 students and trainees, and a $5.7 billion economic impact on metro Atlanta.


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