News & Analysis
with a UTI who did not have a catheter, the CDC found that more than one-third of those cases involved mistakes that could contribute to resistance. For example, samples were not taken before initiating therapy, doses were incorrect, therapy was not reevaluated after 48 hours, or antibiotics were administered for too long. “The data on surveillance are no surprise, but it is important to have numbers to support stewardship programs,” said Helen Boucher, MD, a physician at Tufts Medical Center and a member of the Infectious Diseases Society of America’s board of directors. She noted that the society has advocated for better stewardship of antibiotics for years. More judicious use of antimicrobials in hospitals could have a big effect. Based on its models, the CDC estimates that a 30% reduction in the use of broad-spectrum antibiotics in hospitals—representing a 5% reduction in overall hospital antibiotic use— could prevent 26% of Clostridium difficile infections related to antibiotic treatment. These reductions could also help prevent spillover transmission of C difficile into the community. To aid all these efforts, the CDC plans to use its anticipated funding boost to build the infrastructure necessary to more quickly identify the emergence of resistant strains. Boucher explained that European public health officials are far ahead of the United States in this regard and can provide detailed information on resistance patterns by country and region.
John R. Combes, MD, senior vice president at the American Hospital Association, said that hospitals recognize the need for improvement and that the association is partnering with other organizations to build a toolkit for stewardship programs. “We must improve our processes, not only to protect our patients, but to protect our antibiotics,” he said.
Stewardship Infrastructure The CDC recommends that each hospital build an antibiotic stewardship program to provide physicians with the information and tools they need to make the right decisions. “Antibiotics are a precious resource, yet for decades we have not had a systematic approach in hospitals across the US to ensure they are used wisely,” said Sara Cosgrove, MD, MS, chair of the Society for Healthcare Epidemiology of America antimicrobial stewardship taskforce, in a statement. “Antimicrobial stewardship programs are a critical step toward stemming the tide of antibiotic resistance and ensuring patients are receiving the right antibiotic, at the right dose and for the right duration.” The CDC recommends that stewardship programs include 7 components: • Dedicated human, financial, and technology resources • A physician or other leader responsible for overall outcomes • A pharmacist leader focused on prescribing
• An action to improve prescribing, such as requiring reassessment of prescriptions after 48 hours for drug choice, dose, and duration • Monitoring of prescribing and resistance patterns • Regular reporting of resistance information to clinicians • Education about resistance and judicious prescribing Boucher, who was hired by Tufts to lead its stewardship program, said that not only were these steps reasonable, but that taking them may also bring other benefits for hospitals. She explained that Tufts has saved millions of dollars by improving its stewardship of antibiotics. Combes emphasized that the recommendations are not intended to limit physicians’ autonomy but to give them the information they need to provide the best care possible. In an age when “health care has become more of a team sport,” he said, the expertise of pharmacists and infectious disease specialists can help a physician choose the right drug. “This shouldn’t be viewed as a bureaucratic obstacle to good clinical care,” he said. “This is good clinical care.” Th e C D C i s a l s o r e c o m m e n d i n g that hospitals work more closely with local public health agencies and neighboring health care facilities to better control the spread of microbes between facilities. “Our hospitals are just one part of a continuous system of care,” said Combes.
WHO: More Than 7 Million Air Pollution Deaths Each Year Bridget M. Kuehn, MSJ
E
xposure to air pollution results in an estimated 7 million deaths each year, said the World Health Organization (WHO),doubleitspreviousestimate.Thissuggests that air pollution—indoor, outdoor, or both—caused 1 in 8 deaths worldwide in 2012. The new estimate is based on more accurate pollution measurements in both urban and rural regions, made possible by newer technologies, and newer evidence linking pollution exposure to poor health. Although pollution has long been recognized as a risk factor in respiratory illnesses such as acute infections and chronic obstructive 1486
pulmonary disease (COPD), newer evidence suggests it also contributes to heart disease, stroke, and cancer. The report estimated that exposure to indoor pollution from coal, wood, and biomass stoves was associated with the deaths of 4.3 million people in 2012. An estimated 2.9 billion people rely on wood, coal, or dung as their primary cooking fuel, according to the report. Without proper venting, burning these fuels indoors can lead to chronic exposure to soot. Overall, the WHO found stroke was t h e m o st c o m m o n c a u s e o f i n d o o r
pollution–related death, accounting for 34% of the deaths, compared with 26% caused by heart disease, 22% from COPD, 12% from acute lower respiratory tract infections among children, and 6% from lung cancer. Heart disease and stroke were tied as the top causes of outdoor pollution– related deaths, each accounting for 40% of deaths from such exposure. Small proportions of the deaths attributable to outdoor pollution were caused by COPD (11%), lung cancer (6%), and acute lower respiratory tract infections in children (3%).
JAMA April 16, 2014 Volume 311, Number 15
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/13/2015
jama.com
with a UTI who did not have a catheter, the CDC found that more than one-third of those cases involved mistakes that could contribute to resistance. For example, samples were not taken before initiating therapy, doses were incorrect, therapy was not reevaluated after 48 hours, or antibiotics were administered for too long. “The data on surveillance are no surprise, but it is important to have numbers to support stewardship programs,” said Helen Boucher, MD, a physician at Tufts Medical Center and a member of the Infectious Diseases Society of America’s board of directors. She noted that the society has advocated for better stewardship of antibiotics for years. More judicious use of antimicrobials in hospitals could have a big effect. Based on its models, the CDC estimates that a 30% reduction in the use of broad-spectrum antibiotics in hospitals—representing a 5% reduction in overall hospital antibiotic use— could prevent 26% of Clostridium difficile infections related to antibiotic treatment. These reductions could also help prevent spillover transmission of C difficile into the community. To aid all these efforts, the CDC plans to use its anticipated funding boost to build the infrastructure necessary to more quickly identify the emergence of resistant strains. Boucher explained that European public health officials are far ahead of the United States in this regard and can provide detailed information on resistance patterns by country and region.
John R. Combes, MD, senior vice president at the American Hospital Association, said that hospitals recognize the need for improvement and that the association is partnering with other organizations to build a toolkit for stewardship programs. “We must improve our processes, not only to protect our patients, but to protect our antibiotics,” he said.
Stewardship Infrastructure The CDC recommends that each hospital build an antibiotic stewardship program to provide physicians with the information and tools they need to make the right decisions. “Antibiotics are a precious resource, yet for decades we have not had a systematic approach in hospitals across the US to ensure they are used wisely,” said Sara Cosgrove, MD, MS, chair of the Society for Healthcare Epidemiology of America antimicrobial stewardship taskforce, in a statement. “Antimicrobial stewardship programs are a critical step toward stemming the tide of antibiotic resistance and ensuring patients are receiving the right antibiotic, at the right dose and for the right duration.” The CDC recommends that stewardship programs include 7 components: • Dedicated human, financial, and technology resources • A physician or other leader responsible for overall outcomes • A pharmacist leader focused on prescribing
• An action to improve prescribing, such as requiring reassessment of prescriptions after 48 hours for drug choice, dose, and duration • Monitoring of prescribing and resistance patterns • Regular reporting of resistance information to clinicians • Education about resistance and judicious prescribing Boucher, who was hired by Tufts to lead its stewardship program, said that not only were these steps reasonable, but that taking them may also bring other benefits for hospitals. She explained that Tufts has saved millions of dollars by improving its stewardship of antibiotics. Combes emphasized that the recommendations are not intended to limit physicians’ autonomy but to give them the information they need to provide the best care possible. In an age when “health care has become more of a team sport,” he said, the expertise of pharmacists and infectious disease specialists can help a physician choose the right drug. “This shouldn’t be viewed as a bureaucratic obstacle to good clinical care,” he said. “This is good clinical care.” Th e C D C i s a l s o r e c o m m e n d i n g that hospitals work more closely with local public health agencies and neighboring health care facilities to better control the spread of microbes between facilities. “Our hospitals are just one part of a continuous system of care,” said Combes.
WHO: More Than 7 Million Air Pollution Deaths Each Year Bridget M. Kuehn, MSJ
E
xposure to air pollution results in an estimated 7 million deaths each year, said the World Health Organization (WHO),doubleitspreviousestimate.Thissuggests that air pollution—indoor, outdoor, or both—caused 1 in 8 deaths worldwide in 2012. The new estimate is based on more accurate pollution measurements in both urban and rural regions, made possible by newer technologies, and newer evidence linking pollution exposure to poor health. Although pollution has long been recognized as a risk factor in respiratory illnesses such as acute infections and chronic obstructive 1486
pulmonary disease (COPD), newer evidence suggests it also contributes to heart disease, stroke, and cancer. The report estimated that exposure to indoor pollution from coal, wood, and biomass stoves was associated with the deaths of 4.3 million people in 2012. An estimated 2.9 billion people rely on wood, coal, or dung as their primary cooking fuel, according to the report. Without proper venting, burning these fuels indoors can lead to chronic exposure to soot. Overall, the WHO found stroke was t h e m o st c o m m o n c a u s e o f i n d o o r
pollution–related death, accounting for 34% of the deaths, compared with 26% caused by heart disease, 22% from COPD, 12% from acute lower respiratory tract infections among children, and 6% from lung cancer. Heart disease and stroke were tied as the top causes of outdoor pollution– related deaths, each accounting for 40% of deaths from such exposure. Small proportions of the deaths attributable to outdoor pollution were caused by COPD (11%), lung cancer (6%), and acute lower respiratory tract infections in children (3%).
JAMA April 16, 2014 Volume 311, Number 15
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of St. Andrews Library User on 05/13/2015
jama.com
