Hospital leaders are running out of excuses for not implementing an antibiotic stewardship program.

The need for action has been made increasingly clear in recent months, led by the Centers for Disease Control and Prevention, which has shouted from the rooftops for attention to the matter, urged hospitals to create a stewardship program, and partnered with several industry groups — including the American Hospital Association — to create an antimicrobial stewardship toolkit.

But after attending an electronic town hall meeting on the subject, I have to wonder what would be a valid reason for not having a formal antimicrobial stewardship program in place or in the works. The two guests of the AHA-led program, Arjun Srinivasan, M.D., associate director for health care-associated infection prevention programs at the CDC and Scott Malaney, president and CEO of Blanchard Valley Health System in Findlay, Ohio, outlined many reasons to initiate such a program.

"Hospitals are in a unique position to limit antibiotic overuse," Srinivasan said before running through a slew of stats on the positive effects of antimicrobial stewardship, such as a possible reduction in Clostridium difficile infections by 50 percent.

Fears about the cost of implementing and sustaining a program may be one major reason why hospitals haven't acted to this point, however, stewardship programs can actually save hospitals and the entire care delivery system money, Srinivasan said.

Additionally, hospitals are in the best position to change physician behavior. Physicians want to do the right thing, I'm sure, but getting them to do anything differently can be like herding porcupines. Hospitals are in a position to make wholesale changes in practices that will affect the largest number of physicians as quickly as possible. Meanwhile, competitive concerns can be minimized by working together with other hospitals in the region to get antibiotic prescribing where it should be.

Blanchard Valley, which has been tackling the problem for close to a decade, is still honing its approach. Malaney noted that it recently decided to put pharmacists in the emergency department to work on medicine reconciliation.

Don't wait for a blockbuster drug to save the day. Srinivasan said that new antibiotics are not going to come quickly enough unless the industry changes its prescribing practices.

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