ARM program helps you track antibiotic resistance trends

Hospitals use antibiotics hundreds of times each day. But while they know how much money they are spending on these medications, they do not know how much they are using. So said John G. Gums, Pharm.D., professor of pharmacy and medicine in the departments of pharmacy practice and community health and family medicine at the University of Florida, Gainesville.

Gums is also director of the Antimicrobial Resistance Management (ARM) program, an ongoing project administered by the University of Florida. Established in 1997, the ARM program uses data supplied by participating hospitals to help spot antibiotic resistance, identify resistance patterns, and offer possible solutions.

Using antibiograms and other information submitted by participating hospitals, ARM compiles and customizes these data. Comparing the information with state, regional, and national data, the ARM program issues confidential reports to show hospitals and hospital pharmacists how to spot antibiotic resistance early and modify their drug use, which can reduce costs and improve treatment of infectious diseases.

Information for six regions of the United States-Northeast, North Central, Northwest, Southeast, South Central, and Southwest- and the country as a whole is available at http://www.armprogram.com/. Data used on the Web site are stripped of any identifying information. The site can generate custom reports comparing national data with regional and state data and show resistance patterns for eight different organisms and several different antibiotics.

The database includes more than 27 million isolates, with details on 48 commonly used antibiotics and 19 pathogens, the most significant of which are Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Proteus mirabilis. The database can be used to view resistance trends for each of these organisms and for four others (Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, and Haemophilus influenzae). This helps hospital pharmacists to choose appropriate antibiotics.

Hospitals enrolling in ARM are now being asked to supply their rates of antibiotic utilization in addition to antibiograms and sensitivity data. The program staff is developing a subprogram to correlate patterns between the rates at which hospitals are using certain antibiotics and the resistance trends that occur. This addition is being made to determine why patterns of resistance occur, Gums explained.

"I had made the assumption that a hospital pharmacy knows how much antibiotic it is using. I found out this is not true," Gums told Drug Topics. A hospital may use eight different versions of ampicillin when different dosage types, pill sizes, and oral and intravenous forms are taken into account, he noted. Each of these is coded differently in hospital pharmacy records, he said, and the total amount of ampicillin being used may not be known. Information generated from these data will serve as a tool for showing a hospital why it has a drug resistance profile when the rest of the hospitals in the area do not.

The pharmaceutical industry is not producing new antibiotics as quickly as they are needed, said Gums. "Programs like ours are more important than they ever were. It's not just that the organisms are getting more intelligent, but our ability to fight those organisms is minimized."

ARM can set up a speaking program with participating hospitals, either on site or via teleconference, to discuss its findings. Physicians and pharmacists who attend these conferences are eligible for continuing education credits through the University of Florida. Gums speaks at hospitals about ARM results three to four times a month.

ARM is still enrolling hospitals. "We are always willing to accept more hospitals regardless of their location," Gums stated. "We have a push to locate and enroll hospitals from the Northeast and Southwest regions, but we would be happy to enroll anybody that wants us to work with them."