Making Antimicrobial Stewardship Simpler: Reporting Tools Could Save Time for Busy Hospital Staff

In the July 25^th  Washington Post Opinion titled, “Superbugs are rising again. Hospitals must regain the edge,” the author takes the view that the U.S. hospitals are regressing in efforts to combat antimicrobial resistance. The COVID-19 pandemic not only caused a shift in focus but had “undone this progress”.

The Washington Post story came just months after University of Michigan research showed physicians treating COVID-19 patients early in the pandemic often reached for antibiotics. In the article in Clinical Infectious Disease  the authors wrote that, “Of 1705 patients with COVID-19, 56.6% were prescribed early empiric antibacterial therapy; [while only] 3.5% (59/1705) had a confirmed community-onset bacterial infection.”      

During the pandemic, physicians faced overwhelming numbers of ill patients and no effective drug therapy. The situation often meant turning to antibiotics as a “just in case” remedy, well before a standard test was run to rule out bacterial infections.  As the COVID-19 pandemic evolved, it was eventually apparent that antibiotics were not helping patients.  Real-time stewardship and surveillance reporting tools might have helped, but while hospitals may have had people and processes in place, some  said that they hadn’t yet invested in the necessary technology.

In 2014, the US Centers for Disease Control and Prevention (CDC) called on all hospitals to implement new antibiotic controls through the Core Elements of Hospital Stewardship Programs.  In the intervening years, hospitals have set about implementing structural and procedural components, but according to some hospitals, often did not invest in technology that could make stewardship simpler and more collaborative. Similarly, national antimicrobial resistance (AMR) strategies and visions for nations such as Australia, South Africa, and United Kingdom have emphasized the importance of data and surveillance, but noted that surveillance systems and processes needed improvement.

For example, the third objective of South Africa’s strategy for 2018 - 2024 discusses how the existing surveillance system should be strengthened through centralized data management and reporting. Surveillance is a critical objective for successful antimicrobial stewardship, but it is also extremely time-consuming and inefficient to do manually. Implementing technological advancements as they become available, such as improved diagnostic testing, data management tools, and surveillance software, may help keep up with the demands of fighting antimicrobial resistance, particularly at scale.  

Despite the 2019 updates to hospital Core Elements that include “Hospital Leadership Commitment: Dedicate necessary human, financial, and information technology resources,” we have continuously encountered experienced and overworked Infectious Disease Pharmacists or Infectious Disease Physicians dedicating weeks of time to consolidating data into spreadsheets for stewardship reports, because many hospitals still lack technologies to streamline data processing.  

Healthcare professionals spend weeks or months to manually consolidate, calculate, and validate data. This is due to the colossal amount of data for stewardship, often exported from legacy Laboratory Information Systems (LIS) and Electronic Medical Records (EMR) systems into spreadsheets that require intensive and tedious labor before any data can be distributed.  Critically, hospital antibiograms, a key component of stewardship reporting requirements, are often built upon spreadsheets which may be outdated and inaccurate by the time they are available for use.  Emblematic of the challenge of manual spreadsheet reporting, one bioMérieux client stated, “[I]f I sat down and did nothing but the antibiogram, it would take me at least two solid weeks.”  Indeed, in one antibiogram study of a single organism at a large hospital going back 6 years, it took between 6 and 10 hours for each year analyzed, and a total of 36 to 60 hours for a single bacterial species. Imagine the time required for the hundreds of organisms that hospitals process.

Hospitals in the U.S. spend an average of $500,000 on Electronic Medical Records software, which is a critical investment, but when it comes to stewardship, it represents only part of the technological resources needed. Further investment in and use of technologies such as reporting software can mean that stewardship staff no longer spend weeks working from spreadsheets and can deliver the all-important antibiograms sooner.  The goals and outcomes for antimicrobial stewardship, from lab and leadership, ultimately require purpose-built stewardship and surveillance tools and not more manual work.