Antibiotic Resistance

Recognition of issues related to the use of antibiotics has been present since their early clinical introduction in the 1940s. Since then, the use of antimicrobials and often inappropriate use of these have been increasing. Antibiotic resistance in the United States kills approximately 23,000 patients a year and incurs over $20 billion in additional medical expenses. Antibiotic stewardship was established to combat this trend and was recognized in 1996 to draw attention to the rising incidents in mortality and morbidity associated with inappropriate use of antibiotics. Antimicrobial agents are at least partially responsible for the development of serious infections, such as Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum B-lactamase producing Enterobacteriaceae, and other infectious agents. The focus of the stewardship programs is to improve clinical outcomes, decrease antibiotic resistance, and decrease healthcare costs. In 2007, stewardship programs were nationally recognized and reinforced by the publication of the stewardship guidelines from the Infectious Disease Society of America (IDSA) in association with the Society of Healthcare Epidemiology of America (SHEA). These guidelines were helpful in developing an institutional program to enhance antimicrobial stewardship. Antibiotics are powerful drugs that are used to combat once fatal diseases. As with any powerful medication, antibiotics carry a wide range of adverse effects. The appropriate use of such agents has a high beneficiary effect that outweighs the risks. However, once antibiotics are unnecessarily used, patients experience no benefits while their susceptibility to the side effects is still present. Moreover, antibiotics disrupt the composition of the infectious agent, leading to bacterial adaptation or mutations, and in turn, to new strains that are resistant to the current antibiotic regimen. The inappropriate use of antibiotics in one patient might develop a resistant strain that spreads to other patients that do not use antibiotics, which makes this issue a pressing public health problem. In 2015, 30% of the outpatient antibiotics prescribed were unnecessary, with acute respiratory infections holding the highest unnecessary use of antibiotics at 50%.