U.S. Antibiotic Awareness Week: Using the NHSN AUR Module to Support Antibiotic Stewardship
In honor of U.S. Antibiotic Awareness Week (USAAW) and Lantana’s continued partnership with the Centers for Disease Control and Prevention (CDC), we provide an update on the nation’s primary system for tracking inpatient antibiotic use and resistance: The National Healthcare Safety Network (NHSN) Antimicrobial Use and Resistance (AUR) Module.
USAAW is an annual week-long observance that raises awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic use. Antibiotic resistance continues to threaten lives in the U.S. with more than 2.8 million antibiotic-resistant infections occurring each year resulting in over 35,000 deaths.1 U.S. hospitals have made great progress towards meeting all seven elements of the CDC Core Elements of Hospital Antibiotic Stewardship Programs to combat antimicrobial resistance and improve patient outcomes through antimicrobial stewardship. As of 2019, 4,395 (89%) acute care hospitals reported having all seven Core Elements in place, compared to only 41% in 2014.2 Hospitals in the U.S. have made encouraging progress in the CDC Core Elements of tracking and reporting antibiotic use over the past five years with 98% and 95% of hospitals meeting them in 2019 compared with 79% and 83%, respectively, in 2014.
The CDC launched the NHSN Antimicrobial Use (AU) Option in 2011 to provide a mechanism for hospitals to report and analyze antimicrobial use. Through partner engagement, targeted education, and the release of a standardized risk adjusted metric, AU Option enrollment and reporting has grown to over 1900 hospitals voluntarily submitting AU data today. Launched in 2014, the Antimicrobial Resistance (AR) Option has grown to over 900 participating hospitals through outreach and promotion of available NHSN analysis reports. Many facilities have integrated the CDC’s Core Elements monitoring and benchmarking from NHSN AU Option to optimize antibiotic use at their facility and/or healthcare system.
The CDC has committed to assisting hospitals on using AUR data to inform their stewardship efforts through development of educational resources, release of new NHSN analysis reports/metrics, and publication of national data. This month, the Lantana AUR Module Team collaborated with CDC colleagues to post two new documents to assist antimicrobial stewardship programs (ASPs) with understanding and using their AUR Module data. The NHSN Standardized Antimicrobial Administration Ratio (SAAR) Guide provides guidance to NHSN AU Option users interested in obtaining a deeper understanding of the SAAR as a risk-adjusted metric and how SAARs can be used by ASPs for antibiotic stewardship. The Team also produced the 2019 AU Option Data Report, the first summary of SAAR distributions and percentages of use for adult, pediatric, and neonatal locations. This report provides actionable data for ASPs, informing stewardship by showing hospitals how their SAARs compare to the national distribution. Further, the percentage of AU by class and drug within a SAAR antimicrobial agent category provides insight into prescribing practices across different patient care locations.
The NHSN AUR Module continues to evolve to meet the needs of ASPs. Future NHSN application releases will include annual aggregate SAAR distributions by location type, an updated AR Option antibiogram report, and an expansion of data quality reports. The Team also plans to include an AU-cumulative attributable difference by SAAR antimicrobial agent category and location type to facilitate facility-specific SAAR target goals. These updates to the application will allow the AUR Module to better support stewardship efforts at facilities and healthcare systems, as we collectively strive toward the goals of improving patient care and reducing antimicrobial resistance.
- Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2019. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf. Accessed November 2, 2020.
- Centers for Disease Control and Prevention. Hospital Antibiotic Stewardship. https://arpsp.cdc.gov/profile/stewardship. Accessed November 2, 2020.