A new study claims that some hospitals are prescribing three times more antibiotics than physicians treating similar patients in other institutions.
Researchers associated with the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) analyzed data from a US national administrative pharmaceutical database and the CDC's Emerging Infections Program (EIP) to assess the potential for improvement of inpatient antibiotic prescribing. Variability in days of therapy for selected antibiotics reported to the National Healthcare Safety Network (NHSN) antimicrobial use was computed, and the impact of reducing inpatient antibiotic exposure on incidence of Clostridium difficile
infection (CDI) was modeled using data from two US hospitals.
The results showed that in 2010, 55.7% of patients discharged from 323 hospitals received antibiotics during their hospitalization, revealing a three-fold difference in usage rates among 26 medical/surgical wards reporting to NHSN. Reviews of treatment in cases of urinary tract infections (UTI), or presumed resistant Gram-positive infections, revealed that in patients without catheters and in patients treated with intravenous vancomycin, antibiotic use could have been improved in 37.2% of the cases. The report was published on March 7, 2014, in the CDC Morbidity and Mortality Weekly Report (MMWR).
“Antibiotic prescribing in hospitals is common and often incorrect. In particular, patients are often exposed to antibiotics without proper evaluation and follow-up. Misuse of antibiotics puts patients at risk for preventable health problems,” concluded lead author Scott Fridkin, MD, of the CDC National Center for Emerging and Zoonotic Infectious Diseases, and colleagues. “Models estimate that the total direct and indirect effects from a 30% reduction in use of broad-spectrum antibiotics will result in a 26% reduction in CDI.”
Studies have demonstrated that treatment indication, choice of agent, or duration of therapy can be incorrect in up to 50% of the instances in which antibiotics are prescribed, exposing patients to potential complications of antibiotic therapy, and without any therapeutic benefit. To assist health-care providers to reduce incorrect inpatient prescribing, information is needed regarding how frequently incorrect prescribing occurs in hospitals and how improving prescribing will benefit patients.
An additional complication of the unnecessary and incorrect use of inpatient antibiotics is the growing problem of antibiotic resistance, creating treatment challenges not only for patients who are exposed to the antibiotics but also for other patients to whom these resistant bacteria spread. Improving the prescribing of antibiotics in hospitals is one important part of a broader strategy to counter the increase in antibiotic resistance.
US Centers for Disease Control and Prevention