A Higher Level of Care
Clostridium difficile
Antibiotics Save Lives, but They Aren’t Always the Right Treatment
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t St. Joseph’s Hospital Health Center, a group of health care professionals has begun a program to address the problems caused by the overuse and misuse of antibiotics. The Antibiotic Stewardship Program (ASP) was established a year and a half ago partly in response to statistics provided by the Centers of Disease Control and Prevention (CDC). According to the CDC, 14,000 deaths annually in the United States alone are linked to Clostridium difficile, also known as C. diff., which can infect patients receiving antibiotics. The ASP’s goal is to reduce healthcare-associated infections through decreased use of antibiotics as well as promoting the appropriate use of these powerful medicines. “Antibiotics are, of course, lifesaving drugs, but we should be careful to use them only when they are really indicated,” says Helen Jacoby, MD, an infectious disease specialist who leads the ASP with Lisa Avery, PharmD, a pharmacy professor at St. John Fisher College Wegmans School of Pharmacy, and Bernie Delello, RPh, St. Joseph’s pharmacy director. “Antibiotics can have risks,” says Dr. Jacoby. “Those risks and benefits need to be balanced, so that we will continue to get the benefits of antibiotics over the long term.”
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St. Joseph’s hospital Health Center
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The pharmacists and physicians who comprise the ASP are targeting their study on fluoroquinolones, broad-spectrum antibiotics that kill a wide range of bacteria. Recognizable medicines such as Cipro, Levaquin and Avelox fit into this category. “These drugs seem to be associated with more people getting C. diff. than a lot of other antibiotics, but it’s not like it can’t happen with other antibiotics,” Dr. Jacoby says. “The risk may be much less for penicillin, but even that’s not zero risk.” Dr. Jacoby says that studies done at other institutions indicate that up to 50 percent of antibiotic use is unnecessary. “We know that antibiotics contribute to C. diff. We know they contribute to bacteria getting more and more resistant,” she adds. “Another problem we, and all hospitals, have is very resistant bacteria developing, especially in patients who’ve been in the hospital for a very long time. The fewer antibiotics you use, the less likely that is to happen.” The risk of getting C. diff. is elevated in a hospital or nursing home setting due to the high rate of exposure to germs. Patients who are already on an antibiotic and are exposed to C. diff. bacteria or C. diff. spores are also more likely to contract the infection. The elderly or
spring 2013
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