VUMC’s Pediatric Antimicrobial Stewardship Program Addresses Resistance Crisis

Antibiotics prevent millions of deaths each year, fighting bacterial infections that could otherwise lead to serious complications or even death. But after years of overuse and inappropriate prescription, various bacteria have become increasingly resistant to antibiotics. Antimicrobial resistance has grown into a major global health emergency, causing nearly 5 million associated deaths worldwide in 2019, according to the Centers for Disease Control and Prevention (CDC).

Stewardship in Sight
To ensure optimum use of antibiotics and other antimicrobial drugs at Vanderbilt University Medical Center (VUMC), a team of physicians and pharmacists created the Vanderbilt Antimicrobial Stewardship Program (VASP). Diligently overseeing all antimicrobial therapy, the VASP team works to improve patient outcomes, reduce antibiotic resistance and reduce health care costs. Sophie Katz, MD, Director of Outpatient Pediatric Antimicrobial Stewardship at VUMC, is on the front lines of this effort. “Most antibiotic use is in the outpatient setting, and 80% to 90% of antibiotic expenditures are outpatient,” Dr. Katz says. “If we’re going to impact change, the outpatient setting is where we’ll get the most bang for our buck.”

The CDC reports that one of every three antibiotic prescriptions, or about 47 million prescriptions every year, are unnecessary. Vanderbilt’s VASP program addresses each of the four core elements identified by the CDC for effective outpatient antibiotic stewardship:

• Commitment
• Action for policy and practice
• Tracking and reporting, and
• Education and expertise

By carefully tracking established metrics on a quarterly basis, Dr. Katz and the VASP team provide feedback to physicians on prescription use around these metrics. The team has also created guidelines for treatment of strep, laryngitis, sinusitis and urinary tract infections, as well as upper respiratory chest infections. Dr. Katz notes that they are working to integrate these guidelines into the electronic health records so clinicians can access and use them more easily.

Overcoming Patient Objections
Another challenge facing Dr. Katz and her colleagues involves countering patient misconceptions about antibiotics. The team tries to help patients understand appropriate antibiotic use by monitoring prescriptions, educating on the dangers of antimicrobial resistance, and offering viable and affordable alternatives to antibiotics.

“We want to educate patients on why you don’t need antibiotics for a virus, and some things you can take instead,” says Dr. Katz. “Many people have learned from COVID-19 that antibiotics don’t help viruses. They’ve also learned there are other things that help, such as Tylenol, ibuprofen, nasal decongestants and even honey, which helps a lot with coughs.”

Dr. Katz’s clinic developed a patient handout to explain alternative treatments, but due to deeply ingrained patient expectations, the education process is ongoing. “There are a lot of patient pressures, especially if they’ve had antibiotics prescribed in the past,” she says. “The patient will say, ‘I was prescribed antibiotics last time, and I got better.’ It’s hard to change people’s thinking around this issue.”

Collaborating with Vanderbilt’s clinical microbiology laboratory, the VASP team balances the dual challenges of managing appropriate antibiotic prescribing and preventing unnecessary usage. It’s painstaking work, marked by trial and error when it comes to patient education, but progress is being made on this critically important issue. “I’ve looked at prescribing trends over the past 10 years, and we are going in the right direction,” Dr. Katz says. “As slow as it might be, I’m hopeful that we’ll see bigger impacts soon.”

To learn more about VHAN’s Antibiotic Stewardship Program, visit VHANHub.com/antibiotics.