Fran Lowry

June 19, 2013

FORT LAUDERDALE, Florida — Providing accurate information to general physicians about the pathogens that affect their community can help them prescribe antibiotics more appropriately.

Mary Jo Garst

Because only a small number of antimicrobials are prescribed in the hospital setting, an effective antimicrobial stewardship program must extend outward and involve community physicians, said Mary Jo Garst, RPh, a staff pharmacist at Gerald Champion Regional Medical Center in Alamogordo, New Mexico.

We provided information about appropriate antibiotic choices in a concise, easy-to-use format to community physicians and other patient-care services in our community, which are often ignored when it comes to antimicrobial stewardship, Garst told Medscape Medical News.

"An effective antimicrobial stewardship program should consider what is going on in the community that could be contributing to the development of resistant strains of pathogens that are being seen in and out of acute care settings," added coauthor Marti Heinze, RN, who is also from Gerald Champion Regional Medical Center.

Garst and Heinze, who make up the center's antimicrobial stewardship team, discussed their experience during a poster session here at the Association for Professionals in Infection Control and Epidemiology 2013 Annual Meeting.

Alamogordo is a town with about 30,000 inhabitants in southern New Mexico. As a small community hospital, the lab at Gerald Champion Regional Medical Center processes a large percentage of cultures in the area, which includes the Holloman Air Force Base.

Research tells us that nearly half of the antibiotics prescribed are not necessary.

"Our Escherichia coli isolates were becoming resistant to ciprofloxacin, which is one of the most commonly prescribed antibiotics for urinary tract infections by community physicians," Heinze reported.

She and Garst became aware that some community and military physicians were prescribing antibiotics for urine cultures that did not exhibit any positive leukocytes or nitrates, which generally indicates colonization, not infection.

"Our idea was that if the correct information was distributed to community and military physician practices, we might be able to influence prescribing patterns, and therefore have an impact on the development of resistant strains in the community," Garst explained. "We found that our physicians were comfortable ordering what they'd been ordering for the past 10, 15, or 20 years, which may or may not be the most appropriate antibiotic choice."

First, they compiled data on infectious organisms and sites of infections for the previous 12 months.

Next, they created charts showing prevalence in their specific area and listing the most effective antibiotics for those pathogens, sorted by cost. They added information from national organizations like the Society of Healthcare Epidemiology and recommendations from expert sources.

The charts also listed all medications available at local pharmacies that could be obtained for $10 or less.

"This was so that physicians would have a reference in case they wanted to see which drug would be the least expensive but still appropriate if they had a patient who did not have drug insurance," Garst said.

The information was distributed to all community physicians, long-term care facilities, home healthcare agencies, and pharmacies in and around Alamogordo.

Feedback has been positive. "Some of the physicians, such as orthopaedic surgeons, told us they really don't need information about urinary tract infections and so on, but for the most part, the pertinent information about the most common organisms that cause infections in our community has been very well received," Garst said.

Marti Heinze

"We hope to influence the prescribing patterns of community physicians to ensure the prudent use of antibiotics through the selection of the most effective targeted treatment for better patient outcomes," Heinze added.

"There are very few new antimicrobials being developed, so the use of antibiotics should be carefully considered by practitioners to try to minimize the development of resistant strains," she said.

Doctors should also take the time to educate their patients about good antimicrobial stewardship, Garst and Heinze note.

"Research tells us that nearly half of the antibiotics prescribed are not necessary. Physicians should explain how antibiotics affect the entire balance of our immune system by eliminating the good bacteria along with any potential bad bacteria," Heinze said.

Marcia Patrick, RN, an infection preventionist based in Tacoma, Washington, who was asked by Medscape Medical News to comment on this poster, noted that this antimicrobial stewardship project "shows real progress. In fact, I'm going to send it to our antibiotic resistance coordinator in Pierce County because it emphasizes that we've got to look at things more as a community rather than in our silos of hospitals and urgent care centers."

"It very clearly says that we have to tackle big problems like antibiotic resistance on a community level, much like flu vaccine. Everybody is involved, including community physicians," Patrick explained. "The more we use them, the less effective they are going to be."

Resistance is a problem, but stopping inappropriate antibiotics boosts sensitivity once again, she noted.

"It takes a few years, but sensitivity does go back up. As we get more antibiotic-resistant organisms, good antimicrobial stewardship involving the community, as we see here, is going to be very, very important," she said.

Ms. Garst, Ms. Heinze, and Ms. Patrick have disclosed no relevant financial relationships.

Association for Professionals in Infection Control and Epidemiology (APIC) 2013 Annual Meeting: Abstract 1-235. Presented June 8, 2013.


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