State Health Agencies Play a Critical Role in Addressing Antimicrobial Resistance

June 02, 2015|8:09 a.m.| Virginia Dolen

As the threat of antimicrobial resistance (AMR) rises throughout the world, the White House has convened more than 150 major food companies, retailers, and human and animal health stakeholders to commit to implementing changes over the next five years to slow the emergence of antibiotic-resistant bacteria, detect resistant strains, preserve the efficacy of our existing antibiotics, and prevent the spread of resistant infections. In recognition of today’s White House Forum on Antibiotic Stewardship, ASTHO commits to supporting the state and territorial health agency role in operationalizing the White House’s five-year National Strategy for Combating Antibiotic-Resistant Bacteria.

“State health agencies are poised to play a crucial role in the prevention of antimicrobial-resistant organisms due to our long history with infectious disease surveillance and control,” says Arkansas Director and State Health Officer Nathaniel Smith, who represents ASTHO at the forum.

Antimicrobial resistance is one of the most pressing public health concerns today, and there is a critical need for comprehensive programs to address this threat. CDC’s report Antibiotic Resistance Threats in the United States, 2013 provides an overview of the burden that AMR poses to the United States, including over two million illnesses and 23,000 deaths annually. This issue is gaining increased recognition at the national level, leading to new opportunities. In the past several months, the White House has released the National Strategy and Action Plan for Combating Antibiotic-Resistant Bacteria, identifying the critical actions that key federal departments and agencies will take.

A Post-antibiotic Era?

“If we're not careful, we will soon be in a post-antibiotic era,” CDC Director Tom Frieden says. “For some patients and some microbes, we are already there.”

State and territorial health agencies play an essential role in addressing resistance because they are responsible for protecting patients across the healthcare system and serve as a bridge between healthcare organizations and the community. With adequate capacity and resources, they can help fight AMR by coordinating and facilitating prevention activities, monitoring resistance across the state, leveraging existing partnerships and resources, and developing policies to improve antimicrobial stewardship through prescribing and use best practices.

“State health agencies are in a unique position to convene and facilitate discussions around surveillance, planning, implementation, and communication strategies for antimicrobial resistance and stewardship at the state level,” according to North Dakota State Health Officer Terry Dwelle.

ASTHO’s stewardship report Combating Antibiotic Resistance: Policies To Promote Antimicrobial Stewardship Programs and web pages describe current state activities across the spectrum of healthcare settings and present a range of opportunities for health agencies to develop or enhance stewardship policies and activities. In a July 2013 survey of healthcare-associated infection coordinators, 69 percent of respondents reported conducting antimicrobial stewardship activities. A May 2014 inventory of state health agency activities found that 33 percent have conducted antimicrobial stewardship needs assessments and 52 percent have partnered to provide antimicrobial stewardship education.

“Antibiotics are, quite simply, essential to the health of our people and people everywhere, so we should do everything in our power to ensure that antibiotics remain effective,” President Barack Obama said in a March Q&A with WebMD. “These vital drugs have saved countless lives over the past century. It’s up to us to make sure they keep saving lives for years to come.”

Antimicrobial Stewardship

Goal 1 of the National Strategy is to “slow the emergence of resistant bacteria and prevent the spread of resistant infections.” State and territorial health agencies’ antimicrobial stewardship programs can ensure judicious antimicrobial use to help slow the emergence of resistance, as well as improve individual patient outcomes, prevent death from resistant infections, and reduce healthcare costs.

To develop stewardship programs and policies, state and territorial health agencies may partner with individual providers, healthcare facilities, and associated organizations (e.g., hospital associations). Health departments can help these partners implement stewardship programs by providing data analysis, technical assistance, and education or communications support. With sufficient resources, they can implement collaborative groups of facilities and other partners to share information, pilot activities, measure outcomes, learn from common experiences, and refine what stewardship “looks like” in different facility settings.

“State health departments have the ability to effectively engage a wide range of stakeholders in an efficient manner to promote antimicrobial stewardship principles,” says Smith. “As an example, the Arkansas Department of Health has recently partnered with our state hospital association and pharmacy organization to engage hospitals in an antimicrobial stewardship collaborative with data sharing components.”


ASTHO has also been engaging state health and agricultural officials to explore collaboration to address issues around antibiotic resistance in human pathogens and its intersection with agriculture. These partners recognize that stewardship is essential in both human and animal settings, and states have an important role promoting these activities. State partners have begun to organize to address these issues, several through One Health committees, allowing this work to also contribute to Goal 2 of the National Strategy: “Strengthen National One-Health Surveillance Efforts to Combat Resistance.” For example, Dwelle reports that the North Dakota state epidemiologist is engaging key leaders and facilitating a One-Health-like process to address antimicrobial resistance in the state.

State and territorial health agencies are critical to addressing AMR and implementing stewardship activities. They can capitalize on new opportunities through the National Strategy, establishing themselves as leaders in this area and building capacity to engage in antimicrobial stewardship needs assessments, education, and implementation. These activities will protect patients across the continuum of care as well as the community, and will preserve the effectiveness of antibiotics for the future. ASTHO is honored to further this work through the White House Forum on Antibiotic Stewardship and supporting the National Strategy.

For more information please see ASTHO's Antimicrobial Stewardship page.

Virginia Dolen

Virginia Dolen, MS, is the director for emerging infections at ASTHO. In this position, she manages ASTHO’s antimicrobial resistance portfolio, supporting state health agency capacity to comprehensively address antimicrobial resistance and implement stewardship activities across settings. Virginia received a Master of Science degree in public health microbiology and emerging infectious diseases from The George Washington University.