Preventing the Spread of Antimicrobial Resistance
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Background
Antimicrobial resistance has become a worldwide problem. Each year in the United States, at least 2 million people acquire an infection with bacteria that is resistant to one or more of antibiotics designed to treat such an infection. Of those, at least 23,000 people die as a direct result.
Antimicrobial resistance not only puts physical strain on patients, it puts enormous economical pressure on the healthcare system. Treatment for antimicrobial-resistant infections is a prolonged and costlier treatment, extended hospital stays, more doctor visits, and greater disability and death compared to those infections easily treated with antibiotics. Although it has been difficult to track the specific economic harms of antimicrobial resistance, some estimates suggest at least $20 billion of excess direct healthcare costs, with an additional $35 billion a year for lost productivity.
Overall, according to the Centers for Disease Control and Prevention (CDC), up to 50 percent of all antibiotics prescribed for people are not needed or are not optimally effective as prescribed. Furthermore, the CDC states that at least 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary, 40-75 percent of antibiotics prescribed in nursing homes may be unnecessary or inappropriate, and 20-50 percent of all antibiotics in U.S. acute care hospitals are either unnecessary or inappropriate.
Healthcare-associated infections (HAIs) are among the leading cause of preventable harm and death in the United States. One in 31 hospitalized patients has at least one HAI at any given time. Annually that means 687,000 patients will contract a HAI with nearly 72,000 dying as a result. An increasing number of these infections are untreatable due to resistance to our current arsenal of antibiotics. Without immediate intervention, antibiotic resistance can make minor infections become life-threatening and put our ability to perform surgical procedures at risk.
Where does SHEA stand?
Since before 1997, The Society for Healthcare Epidemiology of America (SHEA) has advocated for prioritizing preventing the spread of antimicrobial resistance through a variety of evidence-based practice and clinical interventions. SHEA strongly believes that antibiotic stewardship programs are a key component in preventing the spread of antibiotic resistance in all healthcare facilities in the US and across the world. Antibiotic stewardship programs optimize antibiotic use to achieve the best clinical outcomes while minimizing adverse events and limiting selective pressures that drive the emergence of resistance and may also reduce excessive costs attributable to suboptimal antibiotic use.
SHEA supports robust investments in the research, development, and implementation of stewardship programs in all healthcare settings. We are asking for $200 million for the Antibiotic Resistance Solutions Initiative in FY 2020, a 19 percent increase over FY 2019 funding levels. We are also seeking increases in investments in FY 2020 for the Combating Antibiotic Resistant Bacteria (CARB) Initiative, funded through efforts at the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ). SHEA applauds the Centers for Medicare & Medicaid Services in finalizing a rule that requires all acute inpatient healthcare facilities to adopt antibiotic stewardship programs as a condition of participation.
What has SHEA done on this issue to date?
SHEA has and will continue to urge policymakers and interested stakeholders to support policies that incentivize the adoption of antibiotic stewardship programs across the U.S. and world. SHEA will also work with other stakeholders to further understand the benefits of antibiotic stewardship for hospital epidemiologists, infection preventionists, healthcare facilities and the patients they serve. To date SHEA has undertaken the following initiatives related to the antibiotic resistance:
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Advocacy for robust federal funding that supports research in antibiotic stewardship and incentivizes the adoption of antibiotic stewardship program in every healthcare setting.
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Committed to the Centers for Disease Control and Prevention’s Antimicrobial Resistance Challenge. Pledge to lead several multi-year programs aimed at creating a standard of practice for appropriate antibiotic use in all inpatient and long-term care facilities in the U.S., with an acceleration in adoption of antibiotic stewardship practices in outpatient settings.
- Advocated for finalizing a rule published by the Centers for Medicare and Medicaid Services that revises the Conditions for Participation for acute inpatient hospitals by updating infection prevention requirements and mandating the adoption of antibiotic stewardship programs.
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Continue to create education and practice resources available for member use in addressing antimicrobial resistance and providing best practices for the prescription of antibiotics
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Collaborate with the CDC Coalition, Coalition for Health Funding, Friends of AHRQ, Research!America, the Stakeholder Forum on Antimicrobial Resistance, and the 22 by 22 Campaign to advance our policy and funding priorities.
What will SHEA do next?
SHEA will continue standing with others from the healthcare community to address antimicrobial resistance. SHEA will also monitor current legislation and regulative efforts in addressing this global problem.
How can I get involved?
SHEA understands and appreciates your desire to stay informed and to get directly involved in SHEA’s next steps. To receive regular updates and to receive instructions on how to get involved, join SHEA’s Grassroots Network by texting PREVENTION to 52886 or sending an email grassroots@shea-online.org with the subject line “Subscribe.”
To become involved on social media, use the hashtag #AntibioticResistance.
Time Line
September 2019
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The Centers for Medicare and Medicaid Services finalized a rule that requires all acute inpatient healthcare facilities to adopt antibiotic stewardship programs as a condition of participation. Find SHEA's Press Release here.
August 2019
- SHEA joins sign on letter, with other organizations, to Senator Sherrod Brown (D-OH) in support of STAAR Act
July 2019
- The STAAR Act (S. 2304) introduced to 116th Congress in the United States Senate
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PRESS RELEASE: Survey Shows Surveillance for Antibiotic-Resistant Bacteria Continues as Core Focus
June 2019
- Saving Lives Through Better Data Act (S. 1793) introduced to 116th Congress in the United States Senate
- Lower Healthcare Costs Act (S. 1895) introduced to 116th Congress in the United States Senate
- Public Health Funding Restoration Act (S. 1944) introduced to 116th Congress in United States Senate
May 2019
- Leading Infrastructure for Tomorrow's (LIFT) America Act (H.R. 2741) introduced to 116th Congress in the U.S. House of Representatives
April 2019
January 2019
October 2018
- PRESS RELEASE: Antibiotic Resistance Increases Relapse in Urinary Tract Infections
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PRESS RELEASE: Sink Traps are Surprising Source of Antibiotic-Resistant Bacteria in ICU
September 2018
June 2018
- PRESS RELEASE: Providers Preferences May be Helpful in Reducing Inappropriate Antibiotic Prescriptions
March 2018
- PRESS RELEASE: Infection prevention and control programs are essential to antibiotic stewardship efforts
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PRESS RELEASE: Troubling Trend in Antibiotic Prescriptions in the Outpatient Setting
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PRESS RELEASE: Infectious Diseases Experts Applaud Legislation to Address Antibiotic Resistance
February 2018
- PRESS RELEASE: Veterans Health Administration Outlines Recommendations to Combat “Crisis” of Multi-Drug Resistant Organisms
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STAAR Act Introduced to 115th Congress (S. 2469) in United States Senate by Senator Sherrod Brown (D-OH)
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SHEA Signs onto open letter, with 39 other organizations, to Senator Sherrod Brown (D-OH) in support of STAAR Act
November 2017
- PRESS RELEASE: Infectious Diseases Experts Train Frontline Clinicians to Research Effective Antibiotic Use
January 2017
November 2016
- PRESS RELEASE: Infectious Diseases Experts Show Support for Policies to Improve Use of Antibiotics in the 21st Century Cures Act
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PRESS RELEASE: Infectious Diseases Experts Promote Effective Antibiotic Use to Combat Drug-Resistant Bacteria
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PRESS RELEASE: Better Use of Antibiotics Needed Throughout Healthcare Settings
September 2016
- PRESS RELEASE: SHEA Comments on UN Meeting on Antimicrobial Resistance
July 2016
- STAAR Act Introduced to 114th Congress (S. 3176) in United States Senate by Senator Sherrod Brown (D-OH)
April 2016
March 2016
- PRESS RELEASE: SHEA Applauds Recommendations of Presidential Advisory Council on Combatting Antibiotic-Resistant Bacteria
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PRESS RELEASE: Effective Antibiotic Controls Needed to Combat Growing Threat of Antibiotic-Resistant Bacteria
February 2016
November 2015
September 2015
- PRESS RELEASE: Ensuring Appropriate Antibiotic Use in Long-Term Care Settings to Improve Patient Care
August 2015
- PRESS RELEASE: Controlling Inappropriate Antibiotic Use Across Settings Provides for Better Patient Outcomes
July 2015
June 2015
April 2015
March 2015
- PRESS RELEASE: SHEA Applauds Strategies Outlined in National Task Force for Combating Antibiotic-Resistant Bacteria Plan
February 2015
- PRESS RELEASE: Unnecessary Antibiotics Frequently Prescribed for Respiratory Infections in Outpatient Settings
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PRESS RELEASE: SHEA Applauds Obama Administration's Request for Funding to Address Antimicrobial Resistance
November 2014
- PRESS RELEASE: Antibiotic Misuse Threatens Modern Medicine
September 2014
- PRESS RELEASE: SHEA Applauds California for Mandating Antimicrobial Stewardship in State's Hospitals
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PRESS RELEASE: SHEA Supports National Strategy to Combat Antibiotic-Resistant Bacteria
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PRESS RELEASE: SHEA Applauds White House on Efforts to Tackle Antimicrobial Resistance Nationally
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PRESS RELEASE: Unnecessary Antibiotic Use in Hospitals Responsible for $163 Million in Potentially Avoidable Healthcare Costs
June 2014
- PRESS RELEASE: SHEA Signs on to the World Alliance Against Antibiotic Resistance (WAAAR) declaration against antibiotic resistance
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PRESS RELEASE: Coordinated Infection Prevention Intervention Shown to Reduce Prevalence of Drug-Resistant CRE in Long-Term Care Facilities
March 2014
- PRESS RELEASE: Healthcare-Associated Infections Reduced in U.S.
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PRESS RELEASE: Inappropriate Antibiotic Use in Hospitals Putting Patients at Risk
June 2013
- STAAR Act Introduced to 113th Congress (H.R. 2285) in United States House by Congressman Jim Matheson (D-UT-4)
April 2012
- Policy Statement on Antimicrobial Stewardship by SHEA, IDSA, and PIDS published
Other Resources
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Health Policy Brief: Antibiotic Resistance. Because overuse and misuse, some antibiotics are losing effectiveness against highly resistant bacteria.
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2017 Antibiotic Use in the United States: Progress and Opportunities
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Centers for Disease Control and Prevention Antimicrobial Resistance Challenge
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Centers for Disease Control and Prevention Vital Signs: Containing Unusual Antibiotic Resistance
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The Core Elements of Antibiotic Stewardship for Nursing Homes
- The Core Elements of Outpatient Antibiotic Stewardship