"It's the same idea. After a day or two, we want clinicians to take an 'antibiotic time out' to assess, very quickly, is the patient on the right antibiotic, the right dose, for the right duration given the symptoms and the results from the culture."
Srinivasan says the CDC has targeted its campaign for hospitalists, internists, intensivists and pediatricians---"anyone who provides inpatient care" who prescribes antibiotics.
But it's also targeting hospital CEOS and administrators with the message that resistance is expensive, resulting in $35 billion in societal costs, $20 billion in excess healthcare costs, and 8 million additional hospital days each year.
"Inpatient antibiotic stewardship programs have consistently demonstrated annual savings of $200,000 to $400,000," reads one part of the campaign.
The agency also is working with the Institute for Healthcare Improvement to eliminate institutional barriers that prevent rapid culture results from getting in front of the physician to stop inappropriate antibiotic use as soon as possible. One strategy is to ask all hospitals to develop a unified system for approaching antibiotic delivery, something Srinivasan calls "stewardship."
That in essence means making a special effort to understand what causes any delays in the process. "Is it in ordering the sample, or collecting the sample, or transporting the sample from the unit to the lab, or is there a delay in the lab? There's a lot of steps involved and the more steps, the more opportunities there are for the system not to work smoothly."