Their formal names are methicillin-resistant Staphylococcus aureus,
Klebsiella pneumoniae and Streptococcus pneumoniae. In the ongoing
battle between deadly infectious organisms and powerful antibiotic
drugs, organisms such as these are winning.
Antimicrobial agents are drugs that have been used in the past 70 years
to treat people with infectious disease; however, some bacteria,
viruses, fungi and parasites have evolved to become resistant or have
adapted to specific drugs making those drugs less effective. According
to the Centers for Disease Control and Prevention (CDC), when a drug of
choice is ineffective, a second or third drug choice may be less
productive and toxic. Hospitals and medical care settings also are
challenged with managing drug-resistant infections due to the risk of
spreading these infections causing longer hospital stays for patients
and sometimes resulting in death.
South Carolina College of
Pharmacy's Roger White, PharmD, professor in the Department of
Pharmaceutical and Biomedical Sciences, is part of an interdisciplinary
team that's focused on this and understanding the usefulness of
antimicrobials and disease.
"Drug resistance is one of the hottest topics in infectious disease
now. We need to use antimicrobials that are currently available in
effective ways so that they will continue to be useful well into the
future. By doing this we improve patient safety, optimize clinical
outcomes and reduce health care costs without impacting quality patient
Finding New Solutions
This is referred to as antimicrobial stewardship and is driven by
multiple factors including the development of resistance to current
antimicrobials as well as the slow development of new antimicrobials by
the pharmacy industry. White and others realize the seriousness of this
and are focused on exploring and finding new solutions.
Several MUSC faculty
members are involved in both regional and local efforts in
antimicrobial stewardship. White, Lisa L. Steed, Ph.D., director of
Diagnostic Microbiology in Pathology and Laboratory Medicine, and Kelly
Goodson, PharmD, Antimicrobial Stewardship Pharmacist are involved in
the effort to fight antimicrobial resistance and improper use through
the Carolinas Antimicrobial Stewardship Effort (CASE).
White and Christopher Ohm,
M.D., from Wake Forest University, founded this grassroots organization
in 2000 to share knowledge and institutional practices in antimicrobial
Today, CASE is an
organization comprised of infectious disease health care practitioners
and public health leaders from North and South Carolina hospitals and
institutions including MUSC, Wake Forest University, Duke University,
the University of North Carolina and the University of South Carolina.
Looking ahead, White and his colleagues anticipate seeing CASE evolve
beyond its role as an educational resource to a service-oriented
organization allowing for more interaction between institutions,
hospitals and health care facilities.
CASE held its annual workshop and conference in Charleston. The
three-day event gathered a multidisciplinary audience of infectious
disease practitioners, pharmacists, nurses, microbiologists, hospital
epidemiologists, public health specialists and MUSC pharmacy students
as well as representatives from academic medical centers and community
hospitals to share information and practices. White, Goodson and Steed
served on the planning committee to organize this event. CASE's success
and reputation in the Carolinas has expanded its potential to grow as a
resource for stewardship with colleagues in the Midwest and other
national locations. CASE regularly collaborates with the CDC and North
and South Carolina's Departments of Health and Environmental Control
Speakers presented on a
variety of topics including a literature review on key antimicrobial
stewardship strategies, data collection, antimicrobial use and
pharmacodynamics (individual dosages), telemedicine and other
CASE-specific projects and workshops.
At MUSC, White is among a multidisciplinary team of pharmacists,
physicians and microbiologists who are focused on using their knowledge
and skills to change hospital practices to more effectively treat
complicated and multi-drug resistant infections within the hospital and
other health care settings.
MUSC established the
Antimicrobial Stewardship service in 2009 to manage the institution's
use and preservation of antimicrobial agents. The service is delivered
by Goodson and two physicians from MUSC's Infectious Disease Division,
Juanmanuel Gomez, M.D. and Sean M. Boger, M.D. In the last few years,
many hospitals and other health care facilities have learned to value
the principles and objectives of antimicrobial stewardship and have
formed more institutionwide teams to address these issues and make
recommendations to implement more effective strategies to patient care
teams, according to White.
establishing a change in attitude among hospital clinicians,
practitioners and administrators is important, according to Steed, who
is one of several advisors on MUSC's stewardship team. "Pathology needs
to receive good quality specimens to conduct tests and manage data.
Staff need to feel that they're part of a team effort that's working
together to advance our knowledge, find solutions and provide the best
care to benefit our patients."
White also thinks
interprofessional collaboration is key to successful stewardship
programs at the local level as well as in organizations such as CASE
that provide education at the regional or national level.