Antimicrobial Stewardship

Implementation of Antimicrobial Stewardship should prevent or slow the emergence of resistance among microorganisms and subsequently reduce patient length of stay, adverse drug events, morbidity, mortality and direct and indirect attendant costs.

Antimicrobial resistance is a substantial threat to public health in the United States. The improper, injudicious and overuse of antimicrobials by physicians, both in the inpatient and outpatient setting is, in part, responsible for the current crisis in antimicrobial resistance. The extent of antimicrobial overuse is exemplified in the outpatient setting by the therapy of respiratory tract infections. Approximately 50% of upper respiratory tract infections and 80% of acute bronchitis are treated with antibiotics despite evidence that antibiotics have little impact in the resolution or outcome of these predominantly viral illnesses. Antimicrobial overuse has contributed to the alarmingly rapid rise in the prevalence of antibiotic-resistant Streptococcus pneumoniae in the US. North Carolina, in fact, has some of the highest levels of S. pneumoniae drug resistance seen in this country.

Similarly, in the hospital and long-term care facility (LTC), antimicrobial resistant pathogens are responsible for infections in increasing numbers of patients, particularly in intensive care units. Infections due to these pathogens result in increased morbidity, mortality, length of hospital stay, and health care expenditure. Preventing the emergence of antimicrobial resistance and the dissemination of resistant microorganisms will reduce these effects and their attendant costs. One of the primary driving forces for the development of antimicrobial resistance in the hospital and LTC is the use of antibiotics themselves. Inappropriate and excessive use of broad-spectrum antibiotics promote emergence of antimicrobial resistance in selected patients, specific patient care units, and within the hospital at large.

The administration and medical staff of Wake Forest Baptist Medical Center (WFBMC) are committed to the principles of sound antimicrobial use both in the inpatient and outpatient communities.