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Antimicrobial Stewardship in Jails and Prisons: When Will Then be Now? – Tufts Medical Center’s Alysse Wurcel, MD, MS

The Levy CIMAR’s Alysse G. Wurcel, MD, MS, presented on “Antimicrobial Stewardship in Jails and Prisons: When Will Then be Now?” Dr. Wurcel is an attending physician in Geographic Medicine and Infectious Diseases at Tufts Medical Center in Boston, a doctor at five county jails in Eastern Massachusetts, and the infectious diseases consultant for the Massachusetts Sheriffs’ Association.

September 30, 2022

Rima Mycynek

The Levy CIMAR kicked off its ’22-’23 seminar series with “Antimicrobial Stewardship in Jails and Prisons: When Will Then be Now?”—a look at racial and social inequalities in antibiotic prescribing practices in carceral facilities. CIMAR’s own Alysse Wurcel, MD, MS, whose research focuses on disparities and equity in healthcare, presented on the subject.

Antibiotics save lives, but whenever they are used, they can also contribute to the development of antimicrobial-resistant (AMR) infections, making antibiotics and similar drugs ineffective against the microorganisms they were created to fight. According to the most comprehensive estimate to date on the global impact of antimicrobial resistance, more than 1.27 million people died in 2019 as a direct result of antibiotic-resistant bacterial infections. (The Lancet, 2022)

Infections of all kinds—tuberculosis, dental infections, HIV, sexually transmitted infections, COVID-19, and more—are common in jails and prisons, making these facilities places where antibiotics are frequently prescribed. Unfortunately, sometimes antibiotics are prescribed even though they are not clinically indicated, the wrong antibiotics are prescribed, or antibiotics are prescribed for too long.

Dr. Wurcel is an attending physician in Geographic Medicine and Infectious Diseases at Tufts Medical Center in Boston and a doctor at five county jails in Eastern Massachusetts. She also serves as the infectious diseases consultant for the Massachusetts Sheriffs’ Association and has published about racial disparities in the prescribing of antibiotics.

Looking at inpatient data for one study, she and collaborators found that Black inpatients were less likely to receive cefazolin and more likely to receive clindamycin compared with White inpatients. Cefazolin is one of the first-line skin and soft tissue infection treatments. Clindamycin is not recommended given frequent dosing and high potential for adverse effects including Clostridioides difficile infection. (JAMA, 2021)

This inequitable prescribing is compounded by the disproportionate number of Black versus White prisoners in carceral facilities. According to data from The Sentencing Project, a nonprofit advocacy center in Washington, D.C., one in three Black men and one in 18 Black women will be incarcerated at some point in their lives, compared with one in 17 White men and one in 111 White women.

“I believe that inefficient and inequitable systems of healthcare can be changed,” says Dr. Wurcel, who advocates for the use of implementation science—or the scientific study of methods and strategies that facilitate the uptake of evidence-based practice and research into regular use. “I want to bring implementation science to help infectious diseases care in jail and prison.”

Dr. Wurcel and colleagues from Tufts Medical Center, Tufts University, and the Levy CIMAR were awarded the Tufts Springboard grant to engage carceral stakeholders (groups and individuals whose influence can impact antibiotic practices) to improve antibiotic stewardship practices in jails and prisons.

The team aim to identify patient, clinician, and institutional factors associated with increased prescribing of antibiotics in New England jails and prisons. They also hope their research will help them understand the perspectives of key stakeholders on barriers and facilitators to implementation of antimicrobial stewardship programs in these carceral facilities.

You can watch Dr. Wurcel’s talk below.

VIDEO: “Antimicrobial Stewardship in Jails and Prisons: When Will Then be Now?” – Tufts Medical Center’s Alysse Wurcel, MD, MS