Expert Spotlight: Dr. Lauri Hicks
There are many things happening in November, but do you know the one that deserves extra special attention? U.S. Antibiotic Awareness Week, which will be observed November 12-18, 2018. It is a key component of the U.S. Centers for Diseases Control and Prevention (CDC) work to combat antibiotic resistance by improving antibiotic use in people and food animals. To celebrate the week, we interviewed Dr. Lauri Hicks, a medical epidemiologist in the Division of Healthcare Quality Promotion, National Center for National Center for Emerging and Zoonotic Infectious Diseases at CDC. Since 2008, Dr. Hicks has been the medical director for the “Be Antibiotics Aware” (formerly “Get Smart: Know When Antibiotics Work”) program, which aims to educate healthcare providers and the public about appropriate antibiotic use. In 2015, she became the director for CDC’s new Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion to improve integration of stewardship across the spectrum of healthcare. She is an Adjunct Assistant Professor of Medicine at the Warren Alpert Medical School of Brown University.
1. Will you tell our readers why U.S. Antibiotic Awareness Week is so important and why/and how they can participate?
Antibiotics are lifesaving drugs that form the foundation of modern medicine. Misuse and overuse of antibiotics, collectively called inappropriate antibiotic use, puts patients at risk and contributes to the problem of antibiotic resistance. Without effective antibiotics, common infections would be untreatable and there wouldn’t be a safety net for patients undergoing cancer chemotherapy and surgery. U.S. Antibiotic Awareness Week is an opportunity for healthcare providers, the general public, veterinarians, and key partners in both human and animal health to come together to share information and strategies for improving antibiotic use. Everyone has a role to play in improving antibiotic use. For more information about the week and how to participate, please visit the CDC website at www.cdc.gov/antibiotic-use
2. U.S. Antibiotic Awareness Week is an international collaboration coinciding with numerous antibiotic awareness observances around the globe. How do you think the global community can work together to address antibiotic stewardship and antibiotic resistance?
International collaboration is key and we must cooperate in order to tackle this problem. We can travel from one side of the globe to another in a matter of hours, which means that antibiotic-resistant bacteria living in and on our bodies can also travel easily from one place to another. Antibiotic resistance anywhere is antibiotic resistance everywhere.
Countries can share information on antibiotic-resistant threats and work together to contain concerning resistance problems. Countries can learn from one another regarding policies that are most effective to improve antibiotic use or tackle antibiotic resistance. One example of collaborative international work is the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR). TATFAR is comprised of government agencies from Canada, EU, U.S., and Norway; government officials are working together on activities and programs that prevent and control antibiotic resistance. Also during US Antibiotic Awareness Week, the World Health Organization observes World Antibiotic Awareness Week. Countries around the globe participate in the observance to raise awareness about antibiotic resistance and the importance of appropriate antibiotic use.
3. You and your team at the CDC Office of Antibiotic Stewardship are focused on improving antibiotic stewardship across the healthcare sector. That’s A LOT! What are some key takeaways that have helped the various sectors become better stewards of antibiotics?
Yes, there is a lot of work to do across all of the healthcare settings. In hospitals, on any given day about half of all patients are receiving antibiotics. Improving antibiotic use in hospitals ensures that patients are receiving the best treatment for their illness. Often patients receive more antibiotics or a longer duration of therapy than is necessary, which doesn’t provide a benefit to the patient and could potentially put them at risk for harms from antibiotics. The good news is that, as of 2017, 76% of hospitals have antibiotic stewardship programs meeting all of CDC’s recommended elements for stewardship programs.
Research has shown that antibiotic stewardship improves the quality of care and protects patients. In outpatient settings, where an estimated 85% of antibiotics are used in humans, we have learned that at least 30% of all prescriptions are unnecessary. Many outpatient prescriptions are used for upper respiratory infections and bronchitis for which antibiotics aren’t needed. There is a lot of room for improvement. Fortunately, we now know that the key to improving antibiotic prescribing in outpatient settings centers on good healthcare provider and patient communication. If the provider thinks the patient wants an antibiotic, she is much more likely to prescribe one. Lack of knowledge is not the biggest driver of inappropriate antibiotic prescribing. Psychosocial factors, like fear and concern about patient satisfaction, are driving forces that we must tackle.
4. We’ve greatly enjoyed working with your team on improving antibiotic stewardship in the urgent care industry. This sector of healthcare is growing so rapidly. What are the best tools available to help urgent care and retail clinics be the best antibiotic stewards possible?
Our work is much more effective when we have strong partnerships. We must be nimble and adjust in response to new needs in the healthcare sector. In 2016, CDC published the Core Elements of Outpatient Antibiotic Stewardship to provide a framework for improving antibiotic use in outpatient settings, including urgent care and retail health. Since we recognized that the urgent care setting is unique, we funded a study to develop a toolkit for urgent care. The toolkit is free and now available online for urgent care leaders interested in improving antibiotic use (http://shea-online.org/images/priority-topics/MITIGATE_TOOLKIT_final.pdf). We have also been working very closely with ARAC and the Urgent Care Association to learn what the industry needs from us. We also want to develop resources for patients who are seeking urgent care to encourage effective communication between provider and patient.
5. What can the general public do to help fight antibiotic resistance?
Whether you are a parent or a patient, you can play a role. Approaching your healthcare provider openly can help ensure that you and your child will be prescribed an antibiotic only when it’s really needed. For example: don’t pressure your or your child’s provider to prescribe antibiotics. Instead, ask what you can do to feel better. Let your or your child’s doctor know that you are worried about antibiotic resistance and that you only want an antibiotic if it is really needed. Also, consumers have really changed the animal agriculture industry through purchasing habits in the grocery store. Many consumers are looking for products that are grown or raised without antibiotics. This consumer demand has led to changes in the agriculture industry.
6. Bonus question that requires changing topics a little! We see that your areas of concentration include outbreak investigations. Tell us about an experience working on an outbreak?
For 10 years of my career at CDC I worked on outbreak investigations. Outbreaks are when there is more disease in a period of time than expected. It’s one of the most exciting and interesting public health roles and it is what we see in movies and on television when we see public health officials. In 2009, when the H1N1 influenza outbreak happened there was a cluster of cases in Chicago. I traveled to Chicago to help lead a team of medical detectives from CDC. We were working to identify the extent of the outbreak, the characteristics of people who developed the disease, and we took samples in order to better understand how it was spreading in households. At the time, early reports indicated that this flu strain may be more dangerous and deadly. Fortunately, while it did cause a lot of disease, it wasn’t as severe as we originally thought. I also supported the Ebola response and many Legionnaire’s disease outbreak investigations. It is extremely gratifying when public health efforts stop disease transmission and protect people from getting sick. It’s why I do what I do.