Eighty years ago, infections like tuberculosis and pneumonia were leading causes of death in the U.S.
Thanks to the advent of antibiotics in the 1940s, that’s not the case anymore. However, these drugs have been used—often overused—for so long that the bacteria the antibiotics are designed to kill have adapted to them, making the drugs less effective. In fact, each year, at least two million people become infected with bacteria that are resistant to antibiotics, and at least 23,000 people die as a result.
“Antibiotic resistance is threatening our progress,”said Dr. David Reynoso, assistant professor of Internal Medicine and deputy director of UTMB’s Antimicrobial Stewardship Program. “In some cases, infections that were thought to have been ‘cured’ are popping up again and antibiotics are no longer effective—it’s like we are going back in time. I have children and, from a personal standpoint, I worry about whether 20 years from now antibiotics will still be around.”
His concern highlights a potentially dire situation—one that UTMB’s Antimicrobial Stewardship Program (ASP) is addressing head on. Led by Professor of Internal Medicine Dr. Philip Keiser, Reynoso and lead pharmacist Dr. Wai-Ying Lam, the program was established about a year ago after The Joint Commission released new regulatory guidelines requiring hospitals to establish an antimicrobial stewardship program. Its role is to promote the appropriate use of antimicrobials, improve patient outcomes and reduce resistance of the bacteria the drugs are intended to combat.
UTMB’s ASP includes a committee made up of physician leaders, infectious disease specialists, pharmacy experts, nurses, information technology specialists, microbiologists and others who meet weekly to discuss targeted work across the institution. The ASP was recently introduced by Health System leadership as one of five focus areas that builds upon the Best Care initiative to help UTMB become a high-value practicing organization.
“We have a great group ranging from content experts to implementation experts,” said Keiser. “Everyone involved is passionate and has a voice when it comes to forming a consensus and a way forward. I’m just ecstatic about how well this group works together—we have a lot we want to accomplish.”
Keiser points to a sobering statistic from the CDC, which shows more than half of all hospitalized patients will receive an antibiotic during their stay—although 30 to 50 percent of antibiotics prescribed are unnecessary or incorrect for the particular bacteria causing the infection.
With that in mind, one of the first initiatives the ASP began was dubbed “handshake stewardship,” which involves Reynoso and Lam walking to inpatient units in Jennie Sealy, shaking hands with medical teams, and offering themselves as a resource trained in infectious disease management and effective use of antimicrobials that can provide informal consultation on proper antibiotic use.
Part education, part relationship-building, the effort has been well-received.
“The ideal we are teaching is to use the narrowest-spectrum antibiotics for the shortest amount of time,” said Reynoso. “Many clinicians are conditioned to overusing antibiotics—I compare it to using a bazooka to kill ants. You don’t always need the strongest weapon. But once the clinician does the appropriate diagnostic tests, we can come by and look at all the data together to help them make an evidence-based choice regarding antibiotics. It’s a culture change, but people have been very receptive.”
Another initiative that is changing the way physicians think about antibiotics is called “antibiotic time outs.” To avoid inappropriate use and misuse, the “time outs” prompt a review of patients receiving antibiotic therapy 48 hours after initiation, with ASP members assisting clinicians in determining the best ways to reduce antibiotic use.
“For a very sick patient who is just admitted to the hospital, it’s important not to withhold anything, so if a physician feels they need various antibiotics, that’s fine. However, we often find that as the days go on, patients no longer need a wide array of antibiotics; they need a very narrow spectrum,” said Lam. “So after 48 hours, we go back to the physician, examine the data, and help the physician make the decision about whether to continue antibiotic use and, if so, how much to give.”
While the ASP is looking into several other projects for the coming year, they have already begun tracking the use of antibiotics across the Health System, and they are noticing a positive trend: antibiotic use is down overall. It’s a trend the ASP says could result in fewer antibiotic-resistant infections, better patient outcomes—and effective antibiotic therapies for generations to come.
For more information on Antimicrobial Stewardship at UTMB, visit
intranet.utmb.edu/best-care.