Published in the July 2009 issue of Today’s Hospitalist
A BIG PART OF A HOSPITAL’S ABILITY to tamp down infection rates is getting a handle on its antibiotic susceptibility and prescribing patterns. A free, national service from the University of Florida in Gainesville allows hospitals to do just that “and it’s looking for facilities across the country to participate.
Founded in 1997, the Antibiotic Resistance Management (ARM) program, directed by John G. Gums, PharmD, has profiled antibiotic-susceptibility trends in more than 400 hospitals nationwide.
Hospitals send in a minimum of three consecutive years’ worth of susceptibility data. In return, says Dr. Gums, participants receive a customized analysis of their hospital’s susceptibility trends benchmarked against national, regional and state resistance trends.
What is particularly helpful, he adds, is when hospitals can “cohort” their data. “Unfortunately, many hospitals lump all their data together,” Dr. Gums says. “That makes it harder to implement strategies in the places for highest return. If you look at ICU isolates vs. non-ICU isolates, for instance, you’ll probably have a different problem.”
Over the past 12 years of analyzing antibiotic resistance in hospitals, Dr. Gums says he continues to see “very alarming trends.” In addition to methicillin-resistant Staph aureus, he notes, “we’re seeing a lot of resistance on the Gram-negative side in hospitals.” A major concern is multidrug-resistant Klebsiella, which Dr. Gums says has exploded across the Eastern seaboard into the Midwest over the past 10 years.
Also escalating is resistance in Pseudomonas aeruginosa, particularly to carbapenems; ditto Enterococci and Proteus. “Even E. coli in the outpatient sector is becoming more resistant to common drugs like Bactrim, which we’ve used to treat UTIs forever,” he says.
And when it comes to Acinetobacter, which is often brought back by veterans from Iraq and Afghanistan, “resistance is now becoming more of a problem in U.S. hospitals,” says Dr. Gums, “particularly in the ICU.”
While the rise in resistance continues to garner headlines, Dr. Gums says we’re missing the other half of the bad bacteria news: the fact that research into new antibiotics has faded away.
“There’s a double-edged sword in terms of the severity of these organisms and growing resistance on one hand,” says Dr. Gums, “and a drop in new antibiotics on the other.” To participate, see the ARM program Web site.