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September 2014
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Presidentís Message: With the Spotlight on Drug Resistance, Itís Time for the ID Specialistís Role in Stewardship to Shine
As my term as president of IDSA comes to a close and I reflect on the past year, I recall that shortly before taking the gavel from David Relman, the Centers for Disease Control and Prevention issued a seminal report on the state of antimicrobial resistance.

So much has happened in the realm of antimicrobial resistance since then: President Obama has requested significant funding to address the problem; the President’s Council of Advisors on Science and Technology (PCAST) has embraced recommendations that closely mirror IDSA policy initiatives; support is building in Congress for legislation that would create a special path to Food and Drug Administration approval for urgently needed new antibiotics; and new antibiotics have come to market, bringing us a little closer to IDSA’s 10x20 Initiative goal.

It is heartening to see that there is growing public awareness and concern around this issue. The threat of antimicrobial resistance is something that we as infectious diseases specialists and IDSA have been sounding an alarm about for years. It was a decade ago that IDSA issued its Bad Bugs, No Drugs report outlining the serious problem we face as well as the steps we believed needed to be taken toward a solution.

What should not be lost in this discussion is the critical role of antimicrobial stewardship programs in preventing drug resistance. Working with our colleagues in the Society for Healthcare Epidemiology of America, IDSA has continued to promote stewardship, most recently by calling for antimicrobial stewardship to be required as a condition of participation for hospitals in the Medicare program.  IDSA will continue our important advocacy to make this policy a reality.  Hospitals and health care systems may embrace stewardship as a cost-saving measure, which is also important, but we need to make the case that stewardship is about providing better patient care—both in terms of making sure that the individual patient receives the right drug (for the appropriate length of time and in the right dose) and in helping to preserve the effectiveness of antibiotics for all of our patients.
Through an ID-led antimicrobial stewardship program, we can provide peer-to-peer consultations on the prescription of antimicrobial treatments based on expert clinical judgment that cannot be provided by any other subspecialty. As ID specialists, we bring to the table a sophisticated knowledge of how antimicrobials work, as well as an in-depth understanding of the relationship between antimicrobial use and the development of drug resistance. We are uniquely qualified to provide leadership to a multi-disciplinary team of healthcare professionals that will effectively engage physicians, nurses, and administrators in a systematic manner. Furthermore, our ability to transition patients from the inpatient setting to more efficient options, employing outpatient parenteral antimicrobial therapy (OPAT), distinguishes us as providers that align patient-centered solutions with value-based care.

IDSA offers a number of helpful resources for developing a stewardship program in its Value of ID Toolkit, including a template on Antimicrobial Stewardship Policy and information on how to provide antimicrobial stewardship services to facilities under co-management or gain-sharing agreements.

IDSA will also continue to advocate for other federal policies that support and promote stewardship, including stronger data collection on antimicrobial drug use and resistance patterns, funding for research to help evaluate the effectiveness of activities to limit the development of resistance and determine best practices, and incentives to stimulate the development and clinical integration of rapid diagnostic tests—a critical tool for stewardship activities.   

As stewards, our job is to keep the focus on better outcomes for our patients and the health care system. We can all agree that the most expensive antibiotic isn’t always the best option, but, if it is, cost should not prevent its use.  At the same time, we must take care to preserve our antimicrobials’ effectiveness and protect our patients from future drug resistance.

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