Less is more: Targeted reduction of antibiotic use in hospitals is possible
Antimicrobial resistance is a growing concern: Hospitals are increasingly being confronted with bacterial infections for which there is no cure. The frequent use of broad spectrum antibiotics, which are effective against many bacteria at the same time, is now taking its toll: It is accompanied by a development of multi-resistant bacteria which find fertile ground in hospitals and jeopardize critically ill patients. An important strategy to get this problem under control is more targeted and intelligent use of antibiotics—which is also termed “antibiotic stewardship” (ABS). In a pilot project, researchers at the University Medical Center Freiburg demonstrated that this strategy can be implemented successfully. The programme could set a precedent. The results were recently published in BMC Infectious Diseases.
"Especially problematic at the moment is the excessive use of so-called third generation cephalosporins and fluoroquinolones. These are very effective antibiotics, but their high consumption results in several multi-resistant problem pathogens developing in hospitals," Prof Winfried Kern from the University Medical Center Freiburg explains. Kern does research at the German Center for Infection Research (DZIF) in the thematic translational unit “Healthcare-associated and Antibiotic-resistant bacterial Infections”, and initiated the German Antibiotic Stewardship Training Programme. He is convinced that antibiotic stewardship programmes can curb the current spread of the dreaded hospital ‘superbugs’, such as clostridium difficile, methicillin-resistant strains of staphylococcus aureus and multidrug-resistant gram negative bacteria. Together with Katja de With, who is now at the University Hospital of Dresden, Kern initiated an intensified ABS programme at the medical service of the University Medical Center Freiburg, and with it reduced the use of critical broad spectrum antibiotics by about 30 percent in one year.
“Achieving this in internal medicine (300 beds) in a university hospital with a total of 1600 beds was a challenge,” Kern admits. University hospitals in particular have critically ill and high-risk patients who frequently require treatment with broad spectrum antibiotics. The Antibiotic Stewardship Programme in Freiburg aimed at reducing the use of cephalosporins and fluoroquinolones while encouraging the use of penicillin derivatives. “From experience we know that penicillin derivatives have a lower risk of promoting the development of the alarming resistant hospital pathogens we have been seeing,” the study leader explains.
The intensified ABS programme built on information and educational interventions, as well as feedback on the use of antibiotics. It revised internal guidelines, trained doctors and used intensified ward rounds, consultations and discussions to not only ensure that the message “use more pens than cephs” was brought across, but also to encourage conducting optimised individual treatment Alongside this, the consumption of antibiotics was both pre-analysed and documented during the study. At certain intervals, the data was statistically processed to indicate trends, which could then be secured with time-series analyses. Several hospital departments which did not participate in the intensified ABS programme were used as controls.
Kern is happy, “The data impressively shows that the programme was not only feasible but also very effective.” Cephalosporin and fluoroquinolone use was reduced by over 30 percent. Although penicillin use simultaneously increased, the programme attained additional net savings through a reduction of the overall amount of antibiotics used and their cost. Winfried Kern is convinced “This is a proof of concept; as the model works in a tertiary-care hospital, it should be transferable to other hospitals." Initial analyses have also shown a positive effect on resistant pathogens. At the DZIF, Kern will continue implementing further antibiotic stewardship programmes. Alongside this, a programme for reducing the use of antibiotics in private practices will also be initiated in Berlin this summer.
