Infectious disease societies frustrated at watching antimicrobial resistance increase for decades are taking the unusual step of asking for federal regulation and oversight of clinical practice, imploring the Centers for Medicare & Medicaid Services (CMS) to require hospitals to implement antimicrobial stewardship programs.
The world is dangerously close to the initial phases of a “post-antibiotic era,” where drug resistant pathogens cause infections that cannot be treated. Antimicrobial stewardship is one of the best ways to head off the crisis, as overused and misused drugs select out resistant organisms and perpetuate the cycle.
While multidrug-resistant pneumococci, gonococci, Salmonella spp, and tuberculosis have developed over the past 30 years, there has been a dramatic drop in the development of new antibacterial agents in the past decade, says the policy statement on antibacterial stewardship, produced by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). (http://bit.ly/HLMJVP)
The major problems are the lack of new antibiotic drugs and the annual increase in antibiotic resistance to organisms found in the community, as well as in intensive care units, and hospitals,.
The chief roadblock to new antibiotic development is financial. An immediate stewardship step to reign in the widespread unnecessary use of antibiotics is roughly equivalent to the first rule of holes: When finding one’s self in one, stop digging.
“Our position is that clearly unless hospitals are forced to participate in antimicrobial stewardship and the government is forced to support new antibiotic drug development, then we will only be in a worse hole and a world of hurt,” says Thomas G. Slama, MD, FIDSA, president, IDSA, and clinical professor of medicine at the Indiana University School of Medicine in Indianapolis, IN.
For more on this important story see the May 2012 issue of Hospital Infection Control & Prevention