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Intermountain leading national charge against antibiotic overuse, 'superbugs'

By Ashley Imlay, KSL | Posted - Nov. 19, 2019 at 8:31 p.m.



SALT LAKE CITY — Emerging “superbugs” threaten to undo progress made in modern medicine, health officials say.

And they’re occurring as a result of overusing something meant to heal — antibiotics.

That’s why Intermountain Healthcare, in collaboration with the University of Utah, announced an initiative Tuesday to battle overprescribing of antibiotics in the Beehive State — and to set a standard. The Centers for Disease Control and Prevention has awarded the organizations a nearly $2 million contract to lead the charge and establish best practices.

“Antibiotics are very unique drugs. They’re the only drug that the more we use them, the less effective they become,” said Dr. Eddie Stenehjem, medical director of antibiotic stewardship at Intermountain Healthcare.

A growing threat

Last week, the CDC released its 2019 antibiotic resistance threat report, which said antibiotic resistant bacteria, or superbugs, infect 2.9 million people each year in the U.S., killing 35,000.

Antibiotic resistance occurs when bacteria develop the ability to “defeat” antibiotics, according to the CDC.

That happens because antibiotics kill good bacteria along with bad bacteria, making way for new types of bad bacteria in a person, said Dr. Adam Hersh, professor of pediatric infectious diseases at the University of Utah.

People don’t become resistant to antibiotics, but bacteria do. And bacteria are shared within communities, making antibiotic resistance a problem for everyone, said Dr. Anthony Wallin, medical director of Intermountain’s urgent care service line.

“For example, if I used antibiotics in my patients in my community and use them a lot, those patients are more likely to have antibiotic-resistant bacteria within them. They can then transfer that bacteria to other family members, other patients, other communities, and then they can get sick with antibiotic-resistant infections as well,” Stenehjem explained.

“This is an issue that we need to address, not just nationally and globally, but an issue we have to address locally and regionally here in Salt Lake City,” he said.

Antibiotic-resistant bacteria has “the potential to undermine many, if not all, of health care advances. Infections with antibiotic resistant bacteria lead to more costly health care, it leads to increased patient suffering, and it also leads to increased patient mortality,” he said. It also leads to problems with treating serious illnesses like cancer.

Utah health care takes the lead

Intermountain Healthcare’s contract with the CDC started last October, and the initiative launched in July. Since then, the organization has seen a 20% decline in antibiotic prescribing in respiratory conditions, according to Stenehjem.

“So far, that’s over 4,000 antibiotic prescriptions not given, and that’s over 30,000 days of antibiotic therapy not given. And that’s a major reduction of antibiotics going into our community,” he said.

Intermountain is also trying to prevent infections through vaccinations, Stenehjem said, and by encouraging safe sex practices, as sexually transmitted infections “are one of the highest-growing” among antibiotic-resistance infections.

When infections do develop in communities, Intermountain wants to limit their spread by detecting them quickly through surveillance.

Intermountain officials are also working to decrease and optimize antibiotic use through what’s called “antibiotic stewardship,” by educating the caregivers in their system as well as their patients about the ways and reasons to limit antibiotic use.

Hersh said the initiative is focusing on decreasing antibiotic prescribing in urgent care settings because between 80% and 90% of antibiotic prescribing happens in outpatient settings like primary care, retail and urgent care clinics. Among those prescriptions, between one-third and one-half of prescriptions “are completely unnecessary, meaning they didn’t need to be prescribed, and the patient is not benefiting from them,” according to Hersh.

In Intermountain’s system, there are 39 urgent care centers that see a total of about 700,000 patients a year.

Hersh said there’s a lot of variability between clinics and clinicians. Some are prescribing antibiotics “most of the time that they see a patient with, say, a cough or a cold,” he said. Others are prescribing them infrequently.

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The initiative seeks to make infrequent prescribing consistent across the system.

Intermountain is also presenting data to its doctors so they can see their own prescribing rates, as well as those of their colleagues.

“It’s very important because physicians, when they see each other and what they’re doing, they tend to make changes. They’re relatively competitive people, so it turns out that that helps quite a bit,” Wallin said.

He said a challenge to convincing doctors to prescribe less is hesitancy around change. “Any human is resistant, and some of our doctors have been practicing 30 years, and you’re changing 30 years of habits,” Wallin explained.

Patients’ perceptions also need to change, Stenehjem said.

“And part of our role, and our clinicians’ role, is to help the patients understand that antibiotics are not benign medications. These are medications that come with risks, and those risks include diarrhea, rash, and development of a type of diarrhea that can kill you,” he said.

Intermountain is trying to change perceptions in patients by talking to them about “watchful waiting” and “delayed prescriptions” — letting one’s body fight respiratory illnesses before turning to antibiotics — as well as symptomatic therapies that can usually be found over the counter, Wallin said.

In the majority of respiratory conditions, according to Stenehjem, antibiotics will do more harm than good.

But he said antibiotics are still beneficial for conditions like urinary tract infections, skin infections, pneumonia, strep throat, and a minority of ear and sinus infections.

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