Fewer than 60% of U.S. hospitals have an antimicrobial stewardship program

Researchers announced that, as of 2014, only 40% of all hospitals have a comprehensive antimicrobial stewardship program (ASP) in place. Furthermore, there was huge range of variation in the percentage of ASPs per state, hospital size, and facility type. This was first assessment of ASPs in the U.S. and was published last week in the Clinical Infectious Diseases.

Using data from the 2014 National Healthcare Safety Network Annual Hospital Survey, researchers found that 50% of American children’s hospital have an ASP that meets all seven components of the Centers for Disease Control and Prevention (CDC) guidelines. Meanwhile, only 43% of general acute care hospitals, 33% of surgical hospitals, and 18% of critical access hospitals have a comprehensive ASP.

The variation is even greater by state, ranging from a high of 58% in California to a low of 7% in Vermont. Hospitals with more than 200 beds have a 59% chance of having an ASP, while only 25% of facilities with fewer than 50 beds have one.

"Overall, 60% of respondents reported hospital leadership commitment to ASPs through either a written statement of support (53%) or salary support for stewardship staff (32%)," the study authors write, saying that leadership support was a strong indicator of a good ASP.

"We were somewhat surprised to find that written support was most strongly predictive," the authors write. "This finding is important in light of the need to expand stewardship programs in smaller hospitals, which are often more resource limited than larger ones."

The Centers for Disease Control and Prevention defines a comprehensive ASP as having seven core elements:
•    Hospital commitment: dedication of human, financial, and information technology resources
•    Reporting: regularly conveying to staff prescribing and resistance patterns
•    Educating: teaching antibiotic resistance and improving prescribing
•    Tracking: monitoring patterns
•    Action: performing at least one prescribing improvement action
•    Drug expertise: having at least one pharmacist responsible for improving antibiotic use
•    Accountability: having someone in leadership responsible for improving outcomes

There have been several efforts to improve antimicrobial stewardship at the national and international level. In January, the CDC and the American College of Physicians released new guidelines for the use of antibiotics for respiratory conditions. The Joint Commission has several resources on antimicrobial stewardship, including a video called “Speak Up: Antibiotics—Know the Facts.”