Hospital leaders must join fight against antibiotic resistance
By Rep. Michael Burgess, M.D.; Ramanan Laxminarayan; and Dr. Philip Polgreen
October 10, 2011 - 12:01 am ET

Hospital CEOs can do more than just prevent an outbreak of influenza in their facility this flu season: They can and must take action against antibiotic resistance, an urgent public health problem that affects us all.

What does the flu have to do with antibiotic resistance and what can a hospital CEO do about it?

Plenty as it turns out.

Research published in the July issue of Infection Control and Hospital Epidemiology shows a dramatic rise in antibiotic prescriptions during flu season. Some of these prescriptions are necessary and appropriate to treat secondary bacterial infections associated with the flu, but many represent instances of antibiotic overuse. The study was funded in part by the Robert Wood Johnson Foundation's Pioneer Portfolio and Extending the Cure, a research project examining the growing problem of antibiotic resistance. Using antibiotics when they are not indicated can harm patients by wiping out good bacteria in the body and cause unpleasant side effects. But overuse also harms society at large by adding to problem of antibiotic resistance—the evolution of microbes that can survive despite treatment with our most powerful drugs.

We all know that people suffering from the flu often demand antibiotics, and doctors often comply even though the patient shows no sign of a bacterial infection. A policy brief by Extending the Cure suggests that up to 1 million antibiotic prescriptions written each year during flu season provide no possible benefit to patients. At the same time, every dose of antibiotics contributes to the development of drug-resistant “superbugs.”

Hospitals on the front lines are already faced with infections that are hard to treat with any antibiotic on the shelf, and the cost of extra treatment often ends up as a negative item on the bottom line.

Reduce overuse

Doctors in hospitals today often must try combinations of once powerful antibiotics, but in some cases, the added effort fails and the patient dies. Resistant organisms that cause lethal infections include methicillin-resistant Staphylococcus aureus, or MRSA, and Acinetobacter baumannii, a microbe becoming increasingly resistant to imipenem, a drug once considered a last-resort treatment.

What can the managers of hospitals and health systems do about this public health problem that kills nearly 100,000 people in the U.S. annually and many more worldwide?

First, they can reduce the overuse of antibiotics by instituting antibiotic stewardship programs in their facilities. Hospitalists, like doctors in the community, must view these drugs as a precious resource that can be depleted if they aren't conserved.

Second, they can cut down on the demand for antibiotics by preventing and limiting the spread of infections. Hospitals should adopt strict infection control procedures and encourage and monitor actions as straightforward as practicing hand hygiene.

Institute compliance plan

Additionally, CEOs must step up the campaign to make sure all hospital workers line up for a flu shot this season. Flu shots can reduce instances of the flu and secondary infections requiring antibiotics, but only about half of hospital workers comply with the Centers for Disease Control and Prevention's recommendation that they get an annual flu shot.

Hospital managers faced with this problem know that simply providing flu shots free of charge doesn't always make a difference. What does? Previous research by the University of Iowa suggests that if the CEO asks all supervisors to report department-wide compliance with flu vaccination, the rates shoot up. The simple step of instituting a reporting system gives hospital workers the incentive to get their flu shots.

By taking these steps, hospital managers would not only help reduce the risk of infectious diseases spreading in their facility, but would also be doing their part to help extend the effectiveness of antibiotics for all of us.

Rep. Michael Burgess (R-Texas), a physician, serves as vice-chairman the health subcommittee of the House Energy and Commerce Committee and as chairman of the Congressional Health Care Caucus. Ramanan Laxminarayan is director of Extending the Cure. Dr. Philip Polgreen is an associate professor at the University of Iowa's Carver College of Medicine in Iowa City and a collaborating investigator for Extending the Cure.