By Cindy Abole
Public Relations

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.

Dr. Roger White

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 care."

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 stewardship.

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.

Recently, 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 programs.

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.

A Multidisciplinary Approach
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.

Dr. Lisa Steed

Communication and 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.