Since the 1940s, antibiotics have significantly reduced morbidity and mortality, but their widespread – and sometimes excessive -- use have come at a price: an alarming rate of antibiotic-resistant bacteria. Indeed, in this country, at least two million people become infected annually with bacteria that are resistant to antibiotics; more than 23,000 die as a result.
Neil Fishman, MD, associate chief medical officer of the University of Pennsylvania Health System, was ahead of his time when he created Penn’s Antimicrobial Stewardship Program (ASP) in 1993. It was one of the first in the country to improve appropriate antibiotic use and cure rates… and it worked. A study performed at the Hospital of the University of Pennsylvania indicated that appropriate antibiotic use increased from 32 to 90 percent, while cure rates rose from 55 to 91 percent.
In the past few years, Keith Hamilton, MD, director of Antimicrobial Stewardship, and the ASP team, which includes pharmacists Shawn Binkley, Steve Morgan, and Daniel Timko, and David Pegues, MD, medical director of Healthcare Epidemiology, Infection Prevention & Control, have taken this surveillance to new levels. Since 2013, electronic alerts have automatically tracked antibiotic use throughout HUP, alerting the team of cases where antibiotic use could be improved. “We collect data from the hospital and review all alerts,” Hamilton said. “We want to make sure all patients receive the right antibiotics as a clinical course evolves.”
In addition, the team is now developing software in collaboration with Teqqa, LLA (a health care informatics company focused on antibiotic stewardship) which will eventually “allow the ASP to break down antibiotic use data by hospital, by unit, by prescriber or by drug, in the inpatient setting as well as by clinic and prescriber in the ambulatory setting,” he said. “We will be able to see patterns – what units use more of one drug than others and then review a random sampling to make sure they’re used appropriately.” Plus, the ability to track practitioners in both the inpatient and outpatient settings allows “personalized feedback to help them improve their individual practices,” he said.
Also in collaboration with Teqqa, the ASP team developed software and a mobile app to deliver real-time relevant data directly to the prescriber’s smartphone. Because antibiotic resistance patterns vary according to location, selecting the right antibiotic can be challenging. “A drug that is effective against a bacterial infection in one hospital or unit may be much less effective at another,” he said. “We’re using UPHS aggregate data to help determine what antibiotics are best, based on demographics, and to deliver that information to the point of care.”
The ASP is also studying the best way to educate providers on appropriate antibiotic use and is developing materials on antibiotic stewardship to educate health care professionals. “This information will hopefully be used to inform how we teach antibiotic use to physicians, nurses, and pharmacists,” he said.
What does the future hold? Personalized antibiotic prescribing, Hamilton said. The ASP and Teqqa are now working on a program to personalize this data even more, predicting what antibiotic works best for a specific patient. “The doctor will enter the patient’s name and the program will automatically pull relevant information from several data bases, such as past infections, recently prescribed drugs, and location of origin [eg, a nursing home], to better predict what antibiotic would be best for that patient.”