Antibiotics and Adverse Events

The Role of Antimicrobial Stewardship Programs in 'Doing No Harm'

Karri A. Bauer; Ravina Kullar; Mark Gilchrist; Thomas M. File Jr.


Curr Opin Infect Dis. 2019;32(6):553-558. 

In This Article

Endorsement From Clinical and Professional Organizations

Nonpayment policies for ADEs by national organizations, such as the Centers for Medicaid and Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations are increasing in prominence and are viewed as an incentive to reduce the incidence of these events. In October 2008, the CMS discontinued additional payments for certain hospital-acquired infections (HAIs) that were deemed preventable [hospital-acquired conditions (present on admission indicator)].[34] The effect of this policy on rates of HAIs was evaluated in 2012. The results revealed that there were no significant changes in quarterly rates of central catheter-associated bloodstream infections in the postimplementation vs. preimplementation period, (incidence-rate ratio, IRR, 1.00; P = 0.97), catheter-associated urinary tract infections (IRR, 1.03; P = 0.08), or ventilator-associated pneumonia (IRR, 0.99; P = 0.52) after the policy implementation. These results demonstrate that although the CMS nonpayment policy may provide organizational awareness in preventing HAIs, a greater focus should be on the design of such nonpayment policies to ensure that they improve outcomes. This policy was expanded in 2015 as part of the hospital-acquired condition Reduction Program under the Affordable Care Act with penalties employed to hospitals as an incentive to prevent costly adverse events and to link payment to programs that drive better health outcomes.[35] Under this initiative, Medicare will penalize over 750 hospitals in 2018 for their lagging performance on measures designed to prevent HAIs.

We recommend that policies that have been implemented by the CMS in preventing HAIs need to be extended to antibiotics to decrease preventable consequences with a focus on patient outcomes. Moreover, specific to AMS, the Joint Commission recently published core standards for ASPs, serving as a national, standardized performance measurement system; however, there were no metrics provided in regard to adverse events related to antibiotics.[36]

Patient safety and HAIs have been on the European Union (EU) and WHO agenda and there is increased consensus that this area should receive more attention from governments. The European Commission released a report in November 2011 evaluating implementation measures to prevent HAIs and increase patient safety.[37] The report calls for greater efforts by Member States on providing information to patients and education and training to healthcare providers. Since then, there has been a greater prioritization of patient safety and HAIs in the EU. At the World Health Assembly organized by the World Health Assembly in May 2019, patient safety was at the forefront of the agenda. Although there has been an emphasis on patient safety in the EU, just like the United States, we recommend these organizations now provide metrics and standards to guide hospitals and hold them accountable in decreasing antibiotic-related ADEs and toxicities, directly impacting patient safety.