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A Wider Lens

Antimicrobial stewardship program at UH defies convention

Innovations in Pediatrics - Spring 2016


Pediatric Infectious Disease Specialist, UH Rainbow Babies & Children’s Hospital; Assistant Professor of Pediatrics, Case Western Reserve University School of Medicine


Pediatrician, UH Rainbow Babies & Children’s Hospital; Assistant Professor of Pediatrics, Case Western Reserve University School of Medicine

Antimicrobial stewardship programs have started to gain traction in children’s hospitals in recent years. A 2015 study in the journal Pediatrics reported that between 2004 and 2012, children’s hospitals that implemented formal programs to monitor antibiotic use reduced prescriptions for certain medications by about 8 percent.

Such a program is in place at University Hospitals Rainbow Babies & Children’s Hospital, led by pediatric infectious disease specialist Ankita Desai, MD.

“In the hospital, any prescription for a broad-spectrum antibiotic gets a review,” she says. “Our process ensures the drug is appropriate. We give recommendations to the prescriber to narrow therapy once cultures confirm the micro-organism. We have a pharmacist dedicated to that task.”

However, the program at UH also includes an unexpected element – a focus on increasing the amount of antibiotic-free meat in the hospital’s supply chain.

“Our approach considers antimicrobial stewardship through a wider lens,” says UH Rainbow Babies & Children’s pediatrician Aparna Bole, MD, who also advises the health system’s Office of Sustainability. “We typically think about the clinical environment – our prescription practices and our patient education. But with more than 80 percent of antibiotics in the U.S. being used in agriculture and most of those for nontherapeutic purposes, we believe it only makes sense to make antibiotic-free meat purchasing part of our antimicrobial stewardship mission. There is a growing body of evidence that links the overuse of antibiotics in agriculture to antibiotic resistance in human pathogens.”

Drs. Desai and Bole made this case to UH clinical leaders. As a result, the hospital system now purchases antibiotic-free ground beef, burger patties and chicken for retail cafeterias, patient meals and catering applications. This represents about 20 percent of the total pounds of meat purchased annually, and UH continues to seek more opportunities to expand antibiotic-free meat purchasing. In January, they presented this novel approach in a national webinar to the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) collaborative, which focuses on establishing best practices for the use of antimicrobials among hospitalized children.

“Judicious use of antibiotics is a really important public health issue to prevent the incredible burden of antibiotic-resistant infections,” Dr. Bole says. “In order to do that, it really takes collective action, not only in the prescribing setting, in the hospital and in primary care, but also in the agricultural and food purchasing settings. I’m proud to say that Rainbow and UH are real leaders in this arena.”

For more information on how to advocate for more antibiotic-free meat in your hospital system, contact Dr. Desai or Dr. Bole at