CDC: Hospitals need to scale back antibiotic use. Here's how.

New report sounds the alarm on overuse, misuse

The overuse and misuse of powerful antibiotics is rampant at U.S. hospitals and has helped fuel the rise of antibiotic-resistant bacteria, according to a CDC study released Tuesday.

WSJ: The next generation of antibiotics

Researchers examined inpatient antibiotic prescribing patterns across hundreds of hospitals and more than 11,000 patients in 2010 and 2011. Looking at a cohort of 323 hospitals in 2010, researchers found that 56% of patients received an antibiotic during their hospitalization. Prescribing practices also varied widely, with physicians at some hospitals prescribing three times as many antibiotics as doctors at other facilities.

The study determined that antibiotics were most often prescribed for:

  • Lung infections (accounting for 22% of all antibiotic prescriptions),
  • Urinary-tract infections (14%); and
  • Suspected infections caused by drug-resistant Staphylococcus bacteria, including methicillin-resistant Staphylococcus aureus (17%).

A closer look at the specific kinds of antibiotics prone to overuse revealed that one-third of prescriptions for vancomycin, a drug that is often reserved as a last resort, and one-third of antibiotics prescribed to treat urinary-tract infections were ordered without proper testing or evaluation. In many cases, patients were kept on the medications for too long, the study found.

According to the study, physicians may be unintentionally fueling the growth of deadly superbugs by overprescribing powerful antibiotics. In addition, the report notes that antibiotic overprescribing can sicken patients by making them more vulnerable to infections like Clostridium difficile. Reducing antibiotic use by 30% could cut the number of C diff infections by 26%, the report estimates.

An opportunity for improvement

President Obama's budget proposal for fiscal year 2015 includes an extra $30 million in funding for CDC initiatives targeted to address an impending surge in antibiotic-resistant bacteria.

How seasonal antibiotic prescriptions can lower a hospital's resistance

During a news conference announcing the study, CDC Director Thomas Frieden implored hospitals to get on board with efforts to cut antibiotic use. "Improving antibiotic prescribing can save today's patients from deadly infections and protect lifesaving antibiotics for tomorrow's patients," he said.

Frieden was joined by the American Hospital Association's John Combes in releasing new tips and instructions that hospitals can employ to curb drug overuse. They recommended that every hospital in the country establish a strong antibiotic stewardship program that includes:

  • A commitment from hospital leadership;
  • A physician who can assume the role of accountability leader;
  • Regular reporting on antibiotic use; and
  • A method of monitoring prescribing and resistance patterns.

Additionally, Frieden and Combes recommended specific tactics for doctors, including:

  • Ordering cultures before giving antibiotics;
  • Verifying that the dosage and indication are clearly stated in the patient's record; and
  • Reassessing prescriptions within 48 hours.

How one hospital eliminated inappropriate antibiotic prescriptions

"We're not saying don't use [antibiotics], we're saying to assess them systematically," Frieden noted. Hospitals that have implemented similar strategies have saved between $200,000 and $900,000 annually, depending on the size and scope of the program (McKay/Bauerlein, Wall Street Journal, 3/4; Reinberg, HealthDay, 3/4; Rice, Modern Healthcare, 3/4 [subscription required]; Sun, Washington Post, 3/4).

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