Antimicrobial Management and Stewardship in the Latest APIC MRSA Elimination Guide

The 2nd edition of Guide to the Elimination of MRSA Transmission in Hospital Settings by APIC outlines the recommendations for antimicrobial stewardship.  According to the Guide, infection preventionists have the responsibility to:
1. Establish timely communication systems to caregivers when MDROs are identified
2. identify MDRO transmission in the acute care setting
3. Recognize MDRO resistance patterns
4. Monitor for and recognize novel resistance
5. Collaborate with laboratory, pharmacy, and other team members to plan and implement effective interventions

In addition, APIC recommends the preparation of annual antibiograms for specific units within a hospital to identify suspected outbreaks within defined areas of the hospital.  IPs should also review the following frequently in order to better understand changes in MRDOs' resistance trends:
1. Compliance with infection prevention policies minimizing transmission risks
2. Changes to infection prevention practices
3. Changing resistance patterns within the community
4. Entry of resistant pathogens or new resistant clones into the facility
5. Addition of medical services
6. Changes to patient populations who are at risk for MRSA and MDROs

CDC considers rule change for pricing of antibiotics

The annual number of antibiotics introduced to the market has been falling around the world. Between 2003 and 2007, only 5 new antibiotics were approved by the FDA in the US. In an effort to encourage the research and development of new antibiotics, the CDC launched a campaign on November 15th to stop the overuse of antibiotics. Key to the campaign is a proposed change in the pricing of these medicines. Currently, pharmaceutical companies have little incentive to develop new antibiotics because new antibiotics are likely to be used only sparingly at first in order to stave off the emergence of resistance. Conservative use of new antibiotics means less profit for the pharmaceutical company, which means it is unlikely to recoup the upfront investment within the fixed patent protection period.

The new solution proposed by the CDC would compensate companies for the true value of the antibiotic. Under the new proposal, new antibiotics will no longer be subjected to the traditional patent period; instead, payment for new antibiotics would be conditioned on meeting conservation and resistance targets set by the CDC. One example could be the rate of emerging resistance. If the company's antibiotic meets the target then it would maintain its market exclusivity. The government hopes that the proposed plan will give incentive to drug companies to develop new antibiotics under the new proposal.

The development of new antibiotics is important because there is an overwhelming number of outbreaks of hospital acquired infections, like MRSA, which could be controlled and treated with these drugs. Among the other diseases that could be targeted by new antibiotics are malaria, anthrax, and tularemia.

New York Times article
Boston Global article