Antibiotics: New CDC Stewardship Program Will Affect Most US Prescribers

John G. Bartlett, MD

Disclosures

July 14, 2016

Approaching the Post-antibiotic Era

Antibiotic resistance has been declared a crisis by the Centers for Disease Control and Prevention (CDC), the World Health Organization, and President Obama. The concern is that we will soon face a "post-antibiotic era." The genesis of this crisis was the failure of new antibiotics to keep pace with resistance and the massive overuse of these drugs. A shocking observation is that on any given day, about 50% of all hospitalized patients in the United States receive antibiotics.[1] The consensus is that antibiotics are given too often, for too long, and are too broad in spectrum.

The CDC has responded with a comprehensive program designed to facilitate the smart use of antibiotics, slow resistance, and improve patient care. All healthcare facilities that receive funding from the Centers for Medicare & Medicaid Services (CMS) will be required to participate in the program, so all healthcare providers who prescribe antibiotics within these facilities will likely be affected.

To help hospitals implement antibiotic stewardship programs, the CDC developed a set of Core Elements of Hospital Antibiotic Stewardship Programs. More than 25 experts and national stakeholders from the public and private sectors, convened by the National Quality Forum's National Quality Partnership, used these core elements to develop the Antibiotic Stewardship Playbook, which is a practical guide to significantly reduce the misuse and overuse of antibiotics.

Stewardship Program Compliance

Both the CMS and The Joint Commission (TJC) are moving toward mandating antibiotic stewardship programs in acute care hospitals. The CMS has issued a proposal that would make antibiotic stewardship programs a condition of CMS participation. [Editor's note: The rule was proposed on June 13 and is currently in a 60-day comment period.] The CMS issued a similar requirement for nursing homes in 2015, and TJC has issued a proposed accreditation standard that would require hospitals and other accredited healthcare facilities to implement antibiotic stewardship programs. It is expected that this standard will be finalized and issued this summer.

Who Is Affected?

The CMS regulation would apply to all hospitals and nursing homes in the United States that receive payment from the CMS. TJC standard would apply to all healthcare facilities (hospitals, nursing homes, and outpatient clinics) accredited by TJC.

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