Province expands program to limit antibiotic overuse
Mount Sinai pioneers microbe resistance fight and saving health costs
A program pioneered in Toronto’s Mount Sinai Hospital to make sure the sickest patients get the right antibiotics only when needed, is being recognized as a gold standard of care.
The antimicrobial stewardship program, which ensures antibiotics are administered judiciously to pa- tients in the intensive care unit, has helped combat antibiotic resistance and save health-care costs. The program has garnered widespread attention. Similar initiatives will be rolled out across all teaching hospitals in Ontario, and a recent editorial in the journal Critical Care called for these kinds of programs to be made mandatory in all ICUs. “We really just want to optimize how antibiotics are used,” said Dr. Andrew Morris, director of the program at Mount Sinai and University Health Network. “This can be part of a safe approach to managing very sick patients and it’s not going to result in harm.” Research shows that about threequarters of patients in ICUs are on antibiotics, but many of them don’t need to be, said Morris, who’s also an associate professor of medicine at the University of Toronto. Patients, he said, are needlessly given antibiotics for various reasons including suspicion of infection, hope of preventing infection, and because some physicians think it’s better to be safe than sorry. Among the key concerns in administering antibiotics to patients when they don’t need them is that they can develop a resistance to
“This can be part of a safe approach to managing very sick patients and it’s not going to result in harm.”
DR. ANDREW MORRIS
drugs, which can result in superbugs. Patients are also at greater risk of contracting C. difficile, a bacterial infection that can damage the bowel and cause diarrhea. It’s especially serious, and potentially fatal, when it attacks the frail or elderly.
Mount Sinai launched the program in 2009. It later expanded it to UHN. Since its inception, there has been a roughly 33-per-cent decrease in antibiotic use and a 40per-cent cut in antibiotic cost.
“The most impressive change we’ve seen is that many patients had infections where we couldn’t use antibiotics or we had very few antibiotics to choose from because of resistance,” said Morris. “Now, those germs are much more susceptible to the antibiotics we use.”
The findings were part of a study Morris and his colleagues published earlier this month in Critical Care. That prompted the editorial this week, written by Dr. Marin Kollef and pharmacist Scott Micek, both of the Barnes-Jewish Hospital in St Louis, Mo.
“The global spread of antimicrobial resistance has become a pressing problem,” they wrote, urging that antimicrobial stewardship programs be made mandatory for all ICUs.
Morris’s team has worked with Accreditation Canada, which accredits all health-care facilities, to develop antimicrobial stewardship as a required practice at all acutecare hospitals beginning in 2013.
The Council of Academic Hospitals of Ontario, which represents teaching hospitals, and the Ministry of Health’s Critical Care Secretariat partnered to give Morris’s program about $1 million in funding to help other teaching hospitals in the province implement a similar model.