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Antibiotic Stewardship

January 27, 2022


Photo: ©Getty Images/Stas_V

Since 2010, VA’s antimicrobial stewardship program has demonstrated to the world how this type of stewardship, practiced at all major health care facilities, can be implemented in large health care settings. One of VA researchers’ significant contributions to this program has been developing interactive information displays to provide feedback to clinicians and pharmacists on their antibiotic prescribing practices. These displays were tested at eight VA facilities and reduced antibiotic overuse compared to VA facilities not yet using these dashboards.

Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antibiotics to reduce microbial resistance. Antibiotics are powerful medicines that fight bacterial infections in people and animals. They are necessary to treat infections, but the overuse and misuse of antibiotics have contributed to antibiotic resistance, which happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow. Antimicrobial resistance in hospitals and communities has risen, and continues to rise, at an “alarming” rate, according to a Veterans Health Administration (VHA) directive (VHA directive 1031), the most recent version of which was published in 2019.

According to a 2020 article in the scientific journal Current Treatment Options for Infectious Disease, however, VA is a leader in fighting antibiotic overuse and misuse. “By embracing multidisciplinary stewardship teams, focusing on education and research in the fields of antimicrobial stewardship, and leveraging the vast data available within the national system, the Veterans Health Administration has made substantial advances in antimicrobial stewardship.”

VA’s outpatient antibiotic prescribing fell about 4% a year between 2011 and 2018, according to a paper delivered in 2021, although antibiotic utilization rose in 2020 as a result of the COVID-19 epidemic, according to another 2021 study.

VA’s antimicrobial stewardship initiative began in 2010 to provide all facilities with guidance on how to develop stewardship initiatives. In 2011, VA established a National Antimicrobial Stewardship Task Force to help guide implementation and development of those initiatives. Today, VHA Directive 1031 requires every VA facility to develop and implement an antimicrobial stewardship program with a written policy, annual evaluation, and adequate dedicated staffing and resources.

VA researchers, led by Dr. Matt Samore, Director of VA’s Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center located in Salt Lake City, have been in the forefront of the Department’s antibiotic stewardship efforts. Samore and others developed dashboards to measure antibiotic use throughout the Department using data from VA’s electronic health records system. The dashboards also provide support to prescribers on the appropriate use of antibiotics. The approach, launched in 2017, was shown in 2020 to have effectively decreased antibiotic overuse in eight VA primary care settings, and demonstrated the potential value to VA and other large health care delivery organizations of providing stewards with robust data on their facility’s antimicrobial utilization.

In other studies, Dr. Samore identified a clindamycin-resistant strain of Clostridium difficile (a bacterium that causes severe diarrhea and colitis) associated with high rates of transmission and in-facility outbreaks across geographically diverse hospitals. He observed that health care workers’ hand carriage (the carrying of microorganism on the hands) strongly correlated with environmental contamination.

In 2019, Dr. Samore received the 2019 Under Secretary’s Award for Outstanding Achievement in Health Services Research, the highest honor for a VA health services researcher.

Selected publications:

Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic. Dieringer TD, Furukawa d, Graber CJ, Stevens VW, Jones MM, Rubin MA, Goetz MB. Infect Control Hosp Epidemiol. 2021 Jun;42(6):751-753. 

How far we’ve come, how far we have to go: a review of advances in antimicrobial stewardship in the Veterans Health Administration. Ramakrishnan A, Patel PK. Curr Treat Options Infect Dis. 2020 Sep;12(3):275-284.

Decreases in antimicrobial use associated with multihospital implementation of electronic antimicrobial stewardship tools. Graber CJ, Jones MM, Goetz MB, Madaras-Kelly K, Zhang Y, Butler JM, Weir C, Chou AF, Youn SY, Samore MH, Glasman PA. Clin infect Dis. 2020 Augg 22;71(5):1168-1176.

Matt Samore, MD, receives 2019 Under Secretary’s Award for Outstanding Achievement in Health Services Research. VA Health Services Research & Development website.

VA reduces antibiotic use in system-wide antimicrobial stewardship initiative, Science Daily, Jan. 25, 2017.

VA’s antimicrobial stewardship program, VA VAntage Point Blog, April 21, 2014.

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