Why Antimicrobial Stewardship Can’t Wait

Antimicrobial resistance is nothing new. Scientists have been warning of it for more than 60 years, as they started to see antibiotic resistance shortly after World War II.1 Despite what history has shown us, and despite early and ongoing warnings from the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO), here we are, in the midst of a global antimicrobial resistance crisis in the 21st century.2-6

The
Eye-Opening
Impact

  • Antimicrobials are proving to be no match for some of the most common infections, including urinary tract infections.6
  • It is becoming increasingly difficult to treat serious infectious diseases like tuberculosis, HIV, and malaria.5
  • Lifesaving medical treatments and procedures like chemotherapy, organ transplantation, and diabetes management are much riskier.5
  • New research shows that bacteria may be starting to resist even alcohol.7
  • The security and safety of the world’s food systems are being threatened.6

By the Numbers

According to a new report released by the United Nations (UN) Interagency Coordination Group (IACG) on Antimicrobial Resistance2:

700,000

people die annually due to drug-resistant diseases

230,000

people die annually due to multidrug-resistant tuberculosis

If no action is taken to combat antimicrobial resistance:

By 2030

24 million

people around the world could be forced into extreme poverty

By 2050

10 million

people could die annually due to drug-resistant diseases, and the global economic burden could be as dire as the 2008-2009 financial crisis

Antimicrobial Stewardship Education

In order to avert the antimicrobial resistance crisis, antimicrobial stewardship is needed on a global scale. Let’s start by defining it. According to the Association for Professionals in Infection Control and Epidemiology, antimicrobial stewardship is10:

“a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.”

The UN IACG on Antimicrobial Resistance recommends that each country6:

  • Implement stronger regulatory systems and increase awareness of “responsible and prudent use of antimicrobials by professionals in human, animal and plant health.”
  • Put more funding and resources behind national antimicrobial stewardship programs, as well as new technologies to help fight antimicrobial resistance.
  • Stop using vital antimicrobials as growth promoters in agriculture.

To practice antimicrobial stewardship, healthcare professionals and facilities should:

  • Ensure antibiotics are being used appropriately. This means using the right drug at the right time and dosage, and for the right duration.11
  • Challenge the use of antibiotics and antiseptics like CHG for inappropriate or non-critical use, preserving their use for times in which there is a clear patient benefit.8,12

The following resources can help clinicians, healthcare facilities, and patients learn more about and practice antimicrobial stewardship:

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References:

  1. STAT website. The surprising history of the war on superbugs — and what it means for the world today. https://www.statnews.com/2016/09/12/superbug-antibiotic-resistance-history/. Accessed May 22, 2019.
  2. UN Ad Hoc IACG on Antimicrobial Resistance. Report to the Secretary-General of the United Nations. No time to wait: securing the future from drug-resistant infections. https://www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG_final_report_EN.pdf?ua=1. Accessed May 22, 2019.
  3. Centers for Disease Control and Prevention website. About antimicrobial resistance: biggest threats and data. https://www.cdc.gov/drugresistance/biggest_threats.html. Accessed May 23, 2019.
  4. World Health Organization website. WHO urges countries to take measures to combat antimicrobial resistance. https://www.who.int/mediacentre/news/releases/2010/amr_20100820/en/. Accessed May 22, 2019.
  5. World Health Organization website. Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Accessed May 22, 2019.
  6. World Health Organization website. New report calls for urgent action to avert antimicrobial resistance crisis. https://www.who.int/news-room/detail/29-04-2019-new-report-calls-for-urgent-action-to-avert-antimicrobial-resistance-crisis. Accessed May 22, 2019.
  7. NBC News website. Drug-resistant superbugs may have just learned a new trick. https://www.nbcnews.com/health/health-news/drug-resistant-superbugs-may-have-just-learned-new-trick-n896606?fbclid=IwAR31dv97Ina4wg2AoIoljPhm0j-ML2jpJKEMTpN1wOeZQ_4lLQYPfcsooqU. Accessed May 23, 2019.
  8. Kampf G. Acquired resistance to chlorhexidine — is it time to establish an ‘antiseptic stewardship’ initiative? J Hosp Infect. 2016. http://dx.doi.org/10.1016/j.jhin.2016.08.018. Accessed May 23, 2019.
  9. Suwantarat N, Carroll KC, Tekle T, et al. High prevalence of reduced chlorhexidine susceptibility in organisms causing central line–associated bloodstream infections. Infect Control Hosp Epidemiol. 2014;35(9):1183-1186. doi:10.1086/677628. http://www.jstor.org/stable/10.1086/677628. Accessed May 23, 2019.
  10. APIC website. Practice resources: antimicrobial stewardship. https://apic.org/Professional-Practice/Practice-Resources/Antimicrobial-Stewardship/. Accessed May 27, 2019.
  11. PEW website. What is antibiotic stewardship—and how does it work? https://www.pewtrusts.org/en/research-and-analysis/articles/2019/02/14/what-is-antibiotic-stewardship-and-how-does-it-work. Accessed May 27, 2019.
  12. Olivi J, Austin CL, Thompson SJ. Antimicrobial effectiveness of rinse-free hospital bathing cleansers after 24 h of initial exposure to common pathogenic micro-organisms. J Pat Care. 2017;3(3):134. doi: 10.4172/2573-4598.1000134. Accessed May 27, 2019.

* Data available upon medical inquiry.