BACKGROUND: In response to antibiotic resistance threats in the United States, state public health departments are taking an active role in antimicrobial stewardship. However, the best way to promote and support antimicrobial stewardship at the state-level is undefined. In Colorado, approximately 30% of hospitals have a comprehensive antimicrobial stewardship program, defined by implementation of all of the Centers for Disease Control and Prevention’s (CDC’s) Core Elements of Hospital Antibiotic Stewardship. Therefore, the Colorado Department of Public Health and Environment (CDPHE) outlined an initial approach to antimicrobial stewardship in Colorado.
METHODS: We incorporated the priorities of CDC, interests of community partners, local antimicrobial resistance and stewardship data, and an analysis of the strengths, weaknesses, opportunities, and threats of our Healthcare-Associated Infections Program into a strategic plan.
RESULTS: Our mission is to support antimicrobial stewardship practices in Colorado across the spectrum of healthcare through 1) statewide leadership, priority setting, and regional data sharing, and 2) expert guidance to healthcare facilities and providers. We propose to offer a voluntary assessment and consultation service to hospitals designed to establish infrastructure and implement the CDC’s Core Elements. The service will be provided by an infectious diseases physician and include education, assessment of antimicrobial stewardship practices, review of antimicrobial use and resistance data, and review of existing facility resources and stewardship goals. Each assessment will inform an action plan with facility-specific objectives and follow-up. In return, we will encourage administrative commitment to antimicrobial stewardship, data sharing, shared experiences among facilities, and feedback. Response metrics will include achievement of facility objectives, implementation of Core Elements, measures of antibiotic use, and Clostridium difficile and antimicrobial resistance data. We will add a more concise assessment to our ongoing Infection Control Assessment and Response in at-risk long-term care facilities. We will also develop a Colorado regional antibiogram and regional measures of antibiotic use.
CONCLUSIONS: Although CDPHE is early in the process, we hope to improve antimicrobial stewardship across Colorado. Our experiences implementing a statewide approach to antimicrobial stewardship, in the context of a variety of approaches in other states, will inform the growing number of public health agencies that are new to this field. While we choose to focus our initial efforts on hospitals and long-term care facilities, in is not clear whether antimicrobial stewardship in hospitals, long-term care facilities, outpatient settings, care networks, or in agriculture will have the greatest impact on antibiotic resistance in our state.