Rush University Medical Center Honored for Careful Use of Antibiotics to Fight ‘Superbugs’

Friday, September 21, 2018

Antibiotic-resistant bacteria kill about 23,000 people in the United States and more than 700,000 people worldwide each year. These “superbugs” may become the greatest health problem of the century, according to the World Health Organization and the Centers for Disease Control and Prevention.

Rush University Medical Center is a national leader in fighting the spread of antibiotic-resistant bacteria, and the Infectious Diseases Society of America recently designated Rush an Antimicrobial Stewardship Center of Excellence. It’s one of only 25 hospitals in the United States to receive this designation, and the only one in Illinois.

The designation, announced Aug. 6, recognizes hospitals that have programs to carefully manage the use of antibiotics and which are led by infectious diseases physicians and pharmacists. According to the IDSA, these stewardship programs “are of the highest quality and have achieved standards established by the Centers for Disease Control and Prevention.”

The designation reflects “the strength of our infectious disease program and our pharmacy, and that hospital leadership have made antimicrobial stewardship and fight against resistant bacteria a commitment and a priority,” said Sarah Won, MD, MPH, medical director of Rush’s antimicrobial stewardship program and an assistant professor in the Division of Infectious Diseases of Rush’s Department of Internal Medicine.

Using antibiotics only when and for how long they’re needed

Between 20 and 50 percent of the antibiotics prescribed in U.S. hospitals “are either unnecessary or inappropriate,” according to the CDC. This overuse of antibiotics contributes to the development of bacteria that can overcome the drugs, putting not only the patient receiving the antibiotic at risk, but anyone else to whom the bacteria spread.

“We want to use our antibiotics judiciously and only when patients really need the antibiotics. When there’s an opportunity, we’re encouraging our providers to utilize microbial data to make the best antibiotic choice,” said Christy Varughese, PharmD, a clinical specialist in infectious disease in Rush’s Department of Pharmacy.

“When each patient comes in, there’s an entire team of pharmacists and doctors who are passionate about making sure the patient gets the best antibiotic and the safest antibiotic for the shortest time possible,” Won added. “We want to make sure that patients who need antibiotics get them, but when you don’t need them we ask, ‘can we stop using them, can we narrow them, can we change them?’

Pharmacy team monitors and guides use of antibiotics

Each day, Rush’s pharmacy team monitors the antibiotics being given to patients in the hospital to determine on a case by case basis if the drug use needs to be continued. In particular, they focus on “broad use” antibiotics – drugs used to fight a wide range of infectious bacteria — and switch to drugs that narrowly target specific bacteria as soon as they’re identified by a patient’s test results.

“Every day, we ask, ‘does the patient still need this?’” Varughese said. When the pharmacists conclude the answer is no, they contact the care team to recommend changes.

In addition, the stewardship team has identified about approximately 30 antimicrobial drugs that should be used with extra caution due to their broad use or toxicity.  “People can’t order them without discussing it with the stewardship team. They’ll get a popup window in Epic (Rush’s electronic medical record system) telling them how to reach us if they want to order it,” Varughese explained.

The stewardship team also has entered guidelines in Epic for what antibiotics to use and whether an infectious disease team member should be consulted about it. Annually, the team creates a summary of which antibiotic to choose for which organism, which they give to doctors and other prescribing health care providers on color-coded cards.

The IDSA’s Center of Excellence program emphasizes this sort of medical staff education and use of the electronic health record. The IDSA designation “says a lot about Rush’s commitment to quality and excellence for our individual patient and for our community,” Won said. “It fits very well with the core values of Rush that we are a center of excellence in antimicrobial stewardship.”

CDC-funded research center, consistent patient safety also guard against superbugs

Rush’s antibiotic stewardship program is just one front in Rush’s fight to curb the spread of superbugs. Rush and Cook County Health and Hospitals System collaboratively operate the Chicago Prevention and Intervention Epicenter, a national leader in research on the spread of antibiotic resistant bacteria and how to prevent it. The CDC has awarded the epicenter nearly $10 million in grants in support of this work.

In addition, Rush makes a concerted effort to prevent the spread of infections of any kind within the hospital as part of its overall commitment to protecting patient safety. This commitment can be seen in Rush having received 13 consecutive ‘A’ grades for safety, the highest possible, from the Leapfrog Group, a patient safety watchdog organization. The Medical Center is one of only 49 hospitals to have received an ‘A’ every time since Leapfrog began warding the twice-yearly grades since 2012.