Driving Antimicrobial Stewardship

Article | 3 Apr, 2018

Unnecessary and Inappropriate Use of Antibiotics Due to Blood Culture Contamination Contributes to Antimicrobial Resistance.

By: Barb DeBaun, RN, MSN, CIC

 

Antibiotics have saved millions of lives since the pivotal discovery of Penicillin in 1928 and are responsible for extending human lives about 10 years1. They remain a critically important treatment tool, but their overuse and misuse have led to a dangerous emergence of multi-drug resistant organisms (MDROs)—urgent concerns for global healthcare, national security, and public health. The threat of antibiotic resistance has become so severe it has garnered federal legislative action. The federal government, CDC, CMS, and The Joint Commission now require acute-care hospitals to implement effective antimicrobial stewardship programs—supporting their collective goal of a 20% reduction in unnecessary/inappropriate use of antibiotics by 2020.

Changes to clinical practice patterns to promote appropriate use of antibiotics are now of paramount importance—especially considering that inappropriate administration of powerful, broad-spectrum antibiotics can be a major contributor to infections and bacteria such as Clostridium difficile Infection (CDI) and Vancomycin-resistant Enterococcus (VRE). Adopting aggressive antimicrobial and laboratory stewardship practices is essential. One such practice is the reduction of blood culture contamination, which may contribute to a misdiagnosis of sepsis and unnecessary administration of antibiotics like Vancomycin. Implementation of mechanical initial specimen diversion technology, exclusive to Steripath, has been demonstrated in clinical trials to virtually eliminate blood culture contamination. This significant improvement in diagnostic testing accuracy supports The National Quality Forum Antimicrobial Stewardship Playbook action for program implementation that recommends avoiding inappropriate treatment of culture contaminants as a method to improve antibiotic use.

Vancomycin is often administered when harmful bacteria are suspected in a patient’s bloodstream. A positive blood culture test result due to contamination, and not a true infection, interfere with discontinuation or de-escalation of therapy. A recent study conducted by the San Antonio Military Medical Center measured the impact of Steripath’s blood culture diversion system on contamination and use of Vancomycin. They found Steripath contributed to a 37% decrease in Vancomycin DOT use hospital-wide. These results matter.  A retrospective analysis of in-patient antibiotic use during 2006-2012 found a significant increase in the use of broad spectrum agents (Vancomycin increased by 32%)2.

The incorporation of Steripath into blood culture collection and contamination prevention practices initiates a ripple effect of quality improvement and positive outcomes. Steripath virtually eliminates blood culture contamination to achieve more accurate results, influencing the reduction of unnecessary and inappropriate antibiotics. The broadest impact is a proven commitment to combating the spread of antibiotic resistance while prioritizing antimicrobial stewardship and overall patient care.

 

“Antimicrobial resistance within a wide range of infectious agents is a growing public health threat of broad concern to countries and multiple sectors…. A post-antibiotic era—in which common infections and minor injuries can kill—far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century.”

Dr Keiji Fukuda, Assistant Director-General Health Security, WHO

 

1. Rise of the Superbug – Antibiotic-Resistant Bacteria: Dr. Karl Klose at TEDxSanAntonio
2. Baggs J, Fridkin SK, Pollack LA, Srinivasan A, Jernigan JA. Estimating National Trends in Inpatient Antibiotic Use Among US Hospitals From 2006 to 2012. JAMA Intern Med.2016;176(11):1639–1648. doi:10.1001/jamainternmed.2016.5651

 

About the Author

Barbara DeBaun, RN, MSN, CIC

Barbara DeBaun is an Infection Prevention/Performance Improvement Advisor. Barbara is adjunct faculty for the MSN Nursing Program at Dominican University and is certified as a TeamSTEPPS Master Trainer. Barbara is an active member of APIC, the Association for Professionals in Infection Control and Epidemiology and recently served two years as an elected member of APIC Board of Directors. Prior to her board service, she served as APIC’s liaison to the Centers for Disease Control’s Hospital Infection Control Practices Advisory Committee (HICPAC).