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:

Advocacy for robust federal funding that supports research in antibiotic stewardship and incentivizes the adoption of antibiotic stewardship program in every healthcare setting.
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.
Continue to create education and practice resources available for member use in addressing antimicrobial resistance and providing best practices for the prescription of antibiotics
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

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
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

February 2018

PRESS RELEASE: Veterans Health Administration Outlines Recommendations to Combat “Crisis” of Multi-Drug Resistant Organisms
STAAR Act Introduced to 115th Congress (S. 2469) in United States Senate by Senator Sherrod Brown (D-OH)
SHEA Signs onto open letter, with 39 other organizations, to Senator Sherrod Brown (D-OH) in support of STAAR Act