A Multidisciplinary Approach to Antibiotic Stewardship Limits Development of Antibiotic Resistance

Author(s):
Thomas Schroeppel, UTHSC; John Sharpe, UTHSC; L Paige Clement, UTHSC; Louis Jude Magnotti, UTHSC; Jordan A Weinberg, UTHSC; Martin Croce, UTHSC; Timothy Fabian, UTHSC

Background:

Antibiotic resistance is a global concern in the healthcare community. Many different strategies exist to limit resistance including de-escalation, antibiotic rotation, and limited duration of therapy for common infections. A unit specific approach including physicians and clinical pharmacists to track organisms and sensitivity patterns can help guide choice of antibiotics with de-escalation as soon as feasible.

Hypothesis:

We hypothesize that a multidisciplinary approach to antibiotic stewardship and utilization will limit development of antibiotic resistance.

Methods:

A review of a prospectively maintained database was performed over a 138-month period ending December 2014. Sensitivities were obtained from all infections in the intensive care unit for Escherichia coli, Acinetobacter baumannii, Enterobacter species, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Serratia marcesans for Gram-negative organisms. Gram-positive organisms included Staphylococcus aureus and Streptococcus pneumoniae. Simple linear regression was used to determine if the sensitivity patterns changed over time.

Results:

The study period spanned from July 2003 to December 2014. There were 5591 total isolates from infections. 

The only sensitivity to worsen was E. coli to ciprofloxacin. The remainder of the Gram-negative organisms either improved or did not change. No changes were observed in Gram-positive organisms.

Conclusions:

Antibiotic resistance is an ongoing concern in the global health community and especially in the intensive care unit. We utilized the same empiric antibiotics (pneumonia, bacteremia, and urinary tract infection) for the 11.5-year study period and have demonstrated stable or improving sensitivity patterns in most organisms. Thus, multidisciplinary approaches including clinical pharmacists and unit specific pathways to common infections rather than mandatory antibiotic rotation will effectively limit antibiotic resistance.