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Tuesday, July 1, 2014

Where Are The Hot Spots For Antibiotic Resistance?

In July, CDC will roll out a new way every hospital in the country can track and control drug resistant bacteria.CDC already operates the National Healthcare Safety Network (NHSN), with more than 12,000 health care facilities participating.  Now we are implementing a breakthrough program that will take control of drug resistance to the next level – the Antibiotic Use and Resistance (AUR) reporting module.  The module is fully automated, capturing antibiotic prescriptions and drug susceptibility test results electronically.
With this module, we’ll be able to create the first antibiotic prescribing index. This index will help benchmark antibiotic use across health care facilities for the first time, allowing facilities to compare their data with similar facilities. It will help facilities and local and state health departments as well as CDC to  identify hot spots within a city or a region.
We’ll be able to answer the questions: Which facilities are prescribing more antibiotics? How many types of resistant bacteria and fungi are they seeing? Do prescribing practices predict the number of resistant infections and outbreaks a facility will face?  Ultimately with this information, we’ll be able to both improve prescribing practices and identify and stop outbreaks in a way we have never done before.
This will help deploy supportive and evidence-based interventions at each facility as well as at regional levels to help stop spread among various facilities.
The need for a comprehensive system to collect local, regional, and national data on antibiotic resistance is more critical than ever. The system now exists, and we need quick and widespread uptake.
Rapid and full implementation of this system is supported through the proposed increase of $14 million contained in CDC’s 2015 budget request to Congress.
With the requested funding increase in future years, CDC would look to develop web-based tools and provider apps so physicians will gain access to facility- and community-specific data via NHSN on the most effective empiric antibiotic for the patient in front of them. For example, a physician in a burn unit treating a patient with a possible staph infection will know what antibiotics that particular microbe is likely susceptible TO and which ones are likely to be most effective.
Instead of broad-spectrum antibiotics being the default choice, as is often the case now, doctors will see recommendations for targeted narrow-spectrum antibiotics that are more likely to be effective and less likely to lead to potentially deadly infections such as C. difficile.
In addition to improving patient care, this information has an economic impact. Health care facilities that have evaluated their prescribing and resistance patterns and instituted effective antibiotic stewardship programs have saved money by reducing the amount of antibiotics they need to purchase and reducing complications, thus reducing their facility-specific cost of treatment.
There’s a great deal of interest in the development of new antibiotics, and some discussion of fast-tracking development of new antibiotics for limited populations. With the new electronic module, we’ll be able to track the use of almost any antibiotic to improve prescribing and prolong the life of new antibiotics as well as those currently in use.  The new module can also contribute to research adverse events related to newly approved antibiotics.
These changes won’t happen overnight, and all of this data won’t be available immediately upon the launch of the module. But with expanded investment, within five years, we should be able to make a real difference and save thousands of live

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