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Mount Sinai answers World Health Day’s call to combat antimicrobial resistance

TORONTO, ON ― April 6, 2011 ― The World Health Organization has declared April 7 as World Health Day and this year’s theme is focused on combating antimicrobial resistance. The major cause of antibiotic resistance is overuse of antibiotics. Mount Sinai Hospital’s Antimicrobial Stewardship Program (known as ASP), which started in February 2009 in the Intensive Care Unit, has been effective in reducing antibiotic-resistant bacterial infections, shown a 24 per cent decrease in antimicrobial use, and reduced the antimicrobial costs per bed by 30 percent. The ASP was expanded in December 2009 to be a joint program with the University Health Network.

The first program of its kind in Canada, the ASP remains the largest in the country. It is supported by Pfizer Canada Inc. and has safely and effectively reduced the use of antibiotics in fighting infections, thereby preserving their effectiveness for future generations. Its success has been achieved through training, educating and collaborating with the inter-professional ICU team, helping them target appropriate antibiotic use for each individual patient.  In this way, it is personalized medicine.

“By using antibiotics too freely we have been giving bacteria the chance to adapt and resist drugs. I am really proud how through education we have been able to instil a culture of respect for antimicrobials and physicians are thinking differently about the way they should be used. This change is allowing us to provide safer and better care for our patients.” said Dr. Andrew Morris, Director, Antimicrobial Stewardship Program, Mount Sinai Hospital and University Health Network.

The traditional approach for treating a patient with a suspected bacterial infection was to prescribe antibiotics, sometimes using drugs that were not effective against the particular infection or using broader spectrum or longer duration of treatment than necessary. This has lead to the rise of super bugs such as C. difficile and Methicillin-resistant Staphylococcus aureus (MRSA), for which current antibiotic treatment is no longer effective.

As part of the ASP at Mount Sinai, an experienced pharmacist now meets with the physicians and residents to look at each patient individually, understand their microbiology results, and answer some critical questions. Is the right antimicrobial being used? Is it too broad or narrow spectrum? Is it the right dose and duration?

“Infectious diseases have always been my primary interest and one of the most common organisms that we see in the ICU is Pseudomonas,” said Sandra Nelson, Clinical Practice Leader, Pharmacy, Mount Sinai Hospital. “Before the program started its sensitivity to treatment was only in the thirty per cent range and we have been able to raise that to almost ninety per cent. It’s very exciting to be part of something that is helping people get better.”

Since the ASP was launched it has been expanded to additional areas of Mount Sinai Hospital and the University Health Network. A new Toronto Antimicrobial Stewardship Corridor has been established, with 13 hospitals participating, thereby expanding the scope of the ASP efforts. The first national course on Antimicrobial Stewardship will be presented this June in Toronto to help hospitals and their healthcare providers increase the capacity and efficacy of ASPs throughout Canada.