Research&Technology ­
Cost control plays role in infecton control: Studies link resistance problems to cost cuts

The studies show that using alternative strategies, such as increasing the variety and dosages of antibiotics administered to a patient, in conjunction with traditional methods of controlling infection, such as isolation, hand washing and decontamination, causes resistant organisms to disappear, while still producing dramatic cost-savings.

The results were presented by Jerome J. Schentag, professor of pharmaceutics at UB and director of the Clinical Pharmacokinetics Laboratory at Millard Fillmore Health System (MFHS) in Buffalo. Schentag is leading research on relationships between bacterial resistance and antimicrobial use at UB and MFHS.

Schentag said that it is not lapses in infection-control procedures, but efforts by hospitals to cut costs, that have created conditions for the antibiotic-resistance problems that now account for an enormous additional health-care expense and a rapidly increasing public-health threat.

"For the past 15-20 years, hospitals have been creating an advantage for the bacteria in the name of cost control," said Schentag. "Predictably, as managed care plays a greater role in the restriction of choice in the community, bacterial resistance patterns will follow the lead into the outpatient setting."

Schentag explained that drug formularies-lists of approved drugs drawn up by hospitals and health insurers-were created during the 1980s to restrict antimicrobial use to only a few, usually less-expensive antibiotics. The traditional practice is to prescribe one drug at a time.

When only one antibiotic is administered to a patient at a time, he explained, bacteria only need to concentrate their resistance efforts on that one drug.

"The result has been the rapid development of resistance as a consequence of cost-control efforts," Schentag said. "The end result for the health-care institution is considerably higher expenditures down the road, as evolving resistance forces the use of more and more of the 'big gun' antibiotics."