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CSTE Supports Antibiotic Resistance Stewardship

Posted By Marion Kainer and Jeffrey Engel, Thursday, July 2, 2015
Updated: Tuesday, June 30, 2015
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On June 2, 2015, the Council of State and Territorial Epidemiologists (CSTE) was one of 150 organizations invited to the White House Forum on Antibiotic Resistance. Representing CSTE was Dr. Marion Kainer, Tennessee Department of Health epidemiologist, and chair of the CSTE Healthcare Associated Infections Subcommittee.

Combatting antibiotic resistant bacteria (CARB) became a presidential priority when the National Strategy for CARB (URL ref. 1) was released in September 2014, and in 2015 President Barack Obama requested $1.2 billion of new funding to address the strategy in his FY 2016 federal budget. In this proposed budget, the Centers for Disease Control and Prevention (CDC) portion is $264 million, a line item that CSTE heavily advocated for during our Capitol Hill visit on March 25, 2015. The National Action Plan for CARB (URL ref. 2) was released in March 2015, a few days after the CSTE Capitol Hill visit.

The new CDC funding would go primarily to the Division of Healthcare Quality Promotion (DHQP) in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Importantly for CSTE members, a portion of the new funding would establish antibiotic resistance and antibiotic use monitoring capacities in state and local health departments. Channeled through the Epidemiology and Laboratory Capacity grant, this capacity building would include a coordinating epidemiologist position and strengthened surveillance with healthcare providers using both the National Health Safety Network and the National Notifiable Diseases Surveillance System. The CSTE national office will benefit as well with expansion of the Applied Epidemiology Fellowship program to include workforce development in antibiotic resistance surveillance and antibiotic use monitoring.

To launch the CARB initiatives and encourage Congress to support the proposed funding, the Executive Office of the President hosted a White House forum. As part of the event, more than 150 food companies, retailers, and human and animal health stakeholders highlighted commitments to implement changes over the next five years to slow the emergence of resistant bacteria and prevent the spread of resistant infections.

The forum started in the Eisenhower Executive Office (EEO) where it was announced that President Obama just signed a presidential memorandum directing federal departments to buy meats and poultry that have been raised using responsible antibiotic-use policies. The forum was opened by Dr. John Holdren, the Director of the Office of Science and Technology Policy, and included addresses by Health and Human Services Secretary Sylvia Burwell, Secretary for Agriculture Tom Vilsack, and CDC Director Tom Frieden. A-five member panel described commitments from their respective organizations; panelists included representatives from human health (acute care and long-term care), the animal health industry, Walmart, and Tyson foods. Walmart stated that in an effort to provide safe, affordable and sustainable food, they are asking meat producers, eggs suppliers and others to use antibiotics only for disease prevention or treatment and not for growth promotion. All five panelists stated that there was a very good business case for antibiotic stewardship. Dr. Jonathan Perlin (from the American Hospital Association and HCA) described the 5 “D”s of antimicrobial stewardship: right Diagnosis, Drug, Dose, Duration and appropriate De-escalation. A video of the opening panel can be found on the White House website.

The attendees were then split into the animal health sector that remained in the EEO and the human health sector group that relocated to the Cash Hall of the Treasury Building. We walked past the West Wing, cut through the North Side of the White House (through areas labeled “no tours beyond here”). The rest of the day was spent in four sessions (each with three panelists) moderated by CDC staff: hospitals (Dr. Arjun Srinivasan), outpatient use (Dr. Lauri Hicks), long term care (Dr. Nimalie Stone) and diagnostics (Dr. Jean Patel). Panelists included Kaiser Permanente and CVS. Both described their use of health information technology to support appropriate antimicrobial use, making it easy for providers to make the right choice; each performed audits and provided provider-specific feedback. They leveraged basic interoperability and infrastructure that was encouraged through meaningful use. Strengthening IT infrastructure, including interoperability, audit, and feedback as well as decision support, was a common theme. Other themes from the day included:
  • Optimal use of data
  • The need for meaningful and valid measures
  • The importance of transparency
  • The ongoing need for better surveillance
  • Financial incentives
  • Better tools (especially diagnostics that communicated results not only to the provider at the point of care, but also to the electronic health records)
  • A need for a “culture change” in healthcare and education and training, including meaningful involvement of patients, families and consumers

Multiple attendees were able to ask questions of the panelists and share perspectives. The human face of antimicrobial resistance was highlighted by the attendance and comments of family members of patients who suffered and/or died from the consequences of antimicrobial resistance.

The CARB initiative is broad in scope, engaging the animal and human health enterprise, the public and private sector, and interventions from prevention to new drug development. CSTE is committed to be the voice for prevention and improved surveillance of antibiotic resistance and use as it affects human health; always at the cutting edge of program and workforce development in applied epidemiology for public health practice.

Marion Kainer, MD, MPH, FRACP, FSHEA is director of the Healthcare Associated Infections and Antimicrobial Resistance Program at the Tennessee Department of Health. Jeffrey Engel, MD is executive director of the Council of State and Territorial Epidemiologists. For more information about antibiotic resistance, please visit CSTE’s Infectious Disease Steering Committee page.

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