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Patients and Providers: A crucial partnership to end the spread of antibiotic-resistant bacteria

Guest post by John Rehm, Nursing@Georgetown Online Community Manager

medications-cure-tablets-pharmacy-51004Antibiotic resistance poses an urgent and growing threat in our country. In fact, the need for action is becoming so critical that the CDC says that without it, “many modern medicines could become obsolete, turning even common infections into deadly threats.” That’s why it’s more important than ever for patients and health care providers — such as physicians and family nurse practitioners — to work together to end the spread of antibiotic-resistant bacteria (ARBs). Here, we’ll take a closer look at ARBs and how this crucial partnership plays a key role in helping to mitigate the threat.

What are antibiotic-resistant bacteria?

According to the Alliance for the Prudent Use of Antibiotics (APUA), antibiotic resistance occurs within bacteria when these medications lose their ability to effectively control or kill bacterial growth. This type of resistance occurs either through genetic mutation or when resistance is acquired through another bacterium. Since bacteria can evolve over time and develop multiple resistant traits, they can become resistant to a variety of different families of antibiotics — which makes them an even greater threat.

In the United States, 2 million people become infected with ARBs each year, and 23,000 die as a direct result. In a 2013 report, the CDC identified the top 18 ARBs that pose a threat at some level — ranging from “urgent” to “concerning.” Although such infections can occur anywhere, most deaths related to antibiotic resistance occur in health care settings. The overuse of antibiotics — both in health care and in animal agriculture — is considered to be the primary contributor to the spread of ARBs.

Empowering patients is key

Although health care providers are typically the focus when it comes to antibiotic stewardship, the role of patients in this dynamic is critical, as well. In an interview with the National Quality Forum, Christian John Lillis, executive director of the Peggy Lillis Foundation (PLF) highlighted the need for patient education and empowerment: “Regarding antibiotics, many people think these medicines should be used to treat viral infections for which they will not work. People also are unaware of the potentially life-threatening conditions, such as C. diff infections, that can result from antibiotic use … . It is important for clinicians to really listen to patients and their caregivers … . It’s also important for patients to encourage better dialogues with their clinicians. If a physician prescribes an antibiotic, people should ask if the medicine is truly needed. Often, it’s not.”

Providing patients with the right resources to deepen knowledge about antibiotic resistance and encouraging them to ask their providers direct questions is key. Five important questions recommended in part by Consumer Reports Health include:

  1. Do I really need antibiotics?
  2. What are the risks?
  3. Are there simpler, safer options?
  4. How much do they cost?
  5. How do I safely take antibiotics?

Patients and providers working together

Such patient empowerment highlights the need for patients and providers to work together to decrease the overuse of antibiotics. The dynamics here can be difficult, since patients often pressure providers to prescribe antibiotics for conditions for which they may not be needed, and providers may feel compelled to prescribe them for a variety of reasons.

In a 2016 post, CDC Director Tom Frieden, MD, MPH, cites a new study published in the Journal of the American Medical Association (JAMA) which found that in an analysis of antibiotic use in U.S. doctors’ offices and emergency departments, at least 30 percent of the antibiotics prescribed were not needed—and that geographically there’s a difference as well, with the highest rates of such patterns occurring in the South. He additionally cites the growing toll of related C. difficile infections, which cause “almost a half a million infections and at least 15,000 deaths” annually. With those types of results, Dr. Frieden highlights the need for health care providers to take the lead in this battle: “As clinicians, it is our job to help our colleagues in the medical community and the American public better understand the risk posed by inappropriate use of antibiotics.”

The author of a 2014 editorial in the Journal of the American Association of Nurse Practitioners (JAANP) concurs with the need for clinicians to step up to the plate. In an article titled, “The urgent need for nurse practitioners to lead antimicrobial stewardship in ambulatory care settings,” Mary Lou Manning PhD, CRNP, CIC, FAAN, says that since advanced practice nurses are on the front lines of patient care — and are often those prescribing antibiotics — they occupy a critical role in both practicing and advocating for antibiotic stewardship.

To support providers, the CDC maintains an antibiotic patient safety atlas, which provides open and interactive data about health care-associated infections (HAIs) caused by ARBs — a key resource to enhance awareness about current infections prevalent in specific geographical areas.

The CDC also offers a variety of resources for both consumers and health care professionals as part of its Get Smart Week that is held every year to “raise awareness of antibiotic resistance and the importance of antibiotic prescribing and use.” Making the most of tools such as these is critical to ensuring that both patients and providers have the information they need to fulfill their role as partners in helping to end the spread of antibiotic resistance.

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