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Safeguarding antibiotics takes tenacity and teamwork

18 November 2020

Pictured: Dr Evan Bursle (back) and Sheryn Wang (front).

Princess Alexandra Hospital’s Antimicrobial Stewardship Team is working hard to support clinicians to achieve optimal patient outcomes today and tomorrow by overseeing the allocation of antibiotics to treat infections across the health service.

Infectious Diseases Physician and Co-chair of Antimicrobial Stewardship Dr Evan Bursle said preserving the miracle of antibiotics for future generations is a goal that hinges on group commitment by the medical fraternity.

“Antimicrobial stewardship is about ensuring antibiotics are used as well as they can be so we can reduce the risk of resistant bacteria proliferating in the environment, and improve outcomes for current and future generations of patients,” he said.

“As antibiotic stewards we look over all the prescribing of antibiotics at Princess Alexandra Hospital at any one point in time. The most important part of stewardship is auditing individual uses of antibiotics to check if each patient is getting the correct antibiotic for the correct duration in the correct dose for their infection.

“Currently we focus on particular teams prescribing over a particular period of time, and once or twice a week we audit what antibiotics are being used within different units, and then feed back to that unit some recommendations about antibiotic selection and dosage. We then follow up to see if those recommendations have been adopted.”

Dr Bursle said stewardship goals were sometimes difficult for clinicians to prioritise, which is why the team was there to provide guidance.

“It is a dilemma for clinicians - they see a patient sick with infection, get worried, and prescribe a broad-spectrum antibiotic to treat it. Although the patient gets better, the antibiotic use increases the likelihood of resistance, and down the track there is a feedback cycle. Perhaps two years later the same doctor must prescribe an even broader spectrum antibiotic to deal with another patient infection because resistance rates have risen.”

Dr Bursle said the concept of intergenerational justice underpins the team’s antibiotic stewardship work.

“The idea that we could lose these drugs if we don’t use them properly today is incredible if you think about it. We won’t be able to do lots of medical procedures we already do with high rates of success.”

Dr Bursle said rampant antimicrobial resistance (AMR) would be catastrophic for patient care.  

“There will be huge rates of post-operative infections, especially for some surgeries like intra-abdominal surgeries, and huge rates of post-operative complications. People won’t be able to complete chemotherapy regimens for cancer, for example, because we won’t have antibiotics to treat the infections that inevitably ensue, and people will also die from normal infections,” he said.

“It’s scary, and there’s no getting away from the fact that by using antibiotics, we contribute to the process of losing them. By exposing organisms to antibiotics, we are encouraging these bugs to evolve to overcome them.”

Team member and Pharmacist Sheryn Wang said getting the balance right is a challenge, but necessary if we are to retain our antibiotic-driven infection-fighting capabilities.  

“It is really walking a tightrope of using antibiotics as optimally as we can today to help patients in the here and now, but also thinking longer-term so we can reduce the harm to a community. We want equal opportunity of outcome not just for patients today but for future generations.”

The pair said the team’s approach to meeting PA Hospital’s obligation to slow down antimicrobial resistance in the community is about partnering, not policing. 

“AMR is a big problem and we’re here to do what we can in partnership with the various medical teams to slow it down.  We try hard to make it a collaboration between teams focused on achieving a quality outcome rather than us telling people what to do.”

Last updated 18 November 2020
Last reviewed 18 November 2020

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