Nov 15, 2017

A Texas Stance Against Resistance

Michael P. Fischer, MD
Infectious Disease Control Unit
Texas Department of State Health Services

Editor’s Note: Nov. 13-19 is Antibiotic Awareness Week. The following post discusses adherence to evidenced-based antibiotic stewardship programs.

The use of antibiotics is the single most important factor leading to antibiotic resistance around the world. In the United States, the Centers for Disease Control and Prevention estimates more than 2 million people are infected with antibiotic-resistant organisms, and approximately 23,000 of these infections result in death annually.  Evidence-based practices and policies are effective in stopping outbreaks and eliminating persistence of antimicrobial-resistant organisms. However, for these prevention efforts to be longstanding and across all spectrums of health care, the continued use of and adherence to evidenced-based antibiotic stewardship programs is critical.

In U.S acute care hospitals, it is estimated that 20 percent to 50 percent of all antibiotics prescribed are either unnecessary or inappropriate.  The promotion of evidence-based antibiotic stewardship programs, which have been shown to improve individual patient outcomes, reduce overall burden of antibiotic resistance, and decrease health care costs, is good medical practice.

In concert with the promotion of antibiotic awareness this week, the Texas Department of State Health Services (DSHS), Emerging and Acute Infectious Disease Branch, has created a new position in its Healthcare Safety Group, that of Texas antibiotic stewardship expert. I am honored to hold that position, where my charge is to help combat antibiotic resistance through education and distribution of materials focused on developing and enhancing antibiotic stewardship programs in all health care settings and communities across Texas.

DSHS’s first antibiotic stewardship initiative is aimed at preventing patient harm from unnecessary antibiotic use in treatment of asymptomatic bacteriuria in long-term care facilities (LTCFs). This initiative supports awareness of asymptomatic bacteriuria, implementation of policies and best practices for ordering culture and sensitivity tests for patients with signs and symptoms of urinary tract infection (UTI), and communication of these test results with antimicrobial therapy review (i.e., antibiotic time-out) in a timely fashion.

DSHS chose this topic and spectrum of health care facilities because antibiotics are among the most commonly prescribed medications in nursing homes. In addition, up to 70 percent of nursing home residents have received at least one course of a systemic antibiotic in a year, and some studies have shown that 40 percent to 75 percent of the antibiotics prescribed in LTCFs may be unnecessary or inappropriate. Many commonly prescribed have been associated with complications, such as diarrhea from Clostridium difficile, which can be more severe and difficult to treat, and lead to more hospitalizations and deaths among people over 65 years old.  By improving the diagnosis and treatment of UTIs in LTCFs, we can see a significant reduction of inappropriately prescribed antibiotics, antibiotic-associated adverse events, and antibiotic resistance.

In addition to the creation of the antibiotic stewardship expert position, the Texas DSHS’s Laboratory Services Section has been designated as one of the seven regional laboratories in the nation that make up the Antibiotic Resistance Laboratory Network. The laboratory performs core testing for the mountain region of the United States (a zone that includes Texas). The lab currently is focused on carbapenem-resistant Enterobacteriaceae characterization and outbreak support, aiding in the salmonella whole genome sequencing program, and detecting new resistant organisms and resistance mechanisms/genes.

This is an exciting addition to DSHS and a wonderful resource for providing Texas’ physicians, health care providers, and communities with information necessary to strengthen their antibiotic stewardship programs and further limit the development and spread of antibiotic resistance in the state.

If you have any questions or comments, please email

1.  CDC. Antibiotic resistance threats in the United States. Atlanta, Ga.: U.S. Department of Health and Human Services, CDC; 2013.
2.  CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, Ga.: U.S. Department of Health and Human Services, CDC; 2014. Available at
3.  Dellit TH, Owens RC, McGowan JE Jr., et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases: an official publication of the Infectious Diseases Society of America. Jan. 15 2007;44(2):159-177.
4.  CDC. The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta, Ga.:
U.S. Department of Health and Human Services, CDC; 2015. Available at: