The U.S. Centers for Disease Control and Prevention (CDC) announced today a new initiative to push hospitals to use antibiotics correctly and judiciously.
A report unveiled Tuesday shows that prescribing practices for antibiotics vary widely across the nation. Antibiotic resistance, fueled in part by over-prescribing, has been a chief concern for the CDC in the past year.
The report found that doctors in some hospitals prescribe up to three times as many antibiotics as those at other hospitals, despite caring for patients with similar needs. Furthermore, errors were identified in the treatment programs for a third of patients with routine urinary tract infections who were given vancomycin, a common and critical antibiotic. These errors included the failure to screen for the bacteria present and the administration of antibiotics for too long.
Researchers also discovered that hospitals that had reduced the use of an antibiotic linked to deadly C. diff diarrheal infections by 30 percent saw a 25 percent drop in the rate of C. diff infections.
“Improving antibiotic prescribing can save today’s patients from deadly infections and protect lifesaving antibiotics for tomorrow’s patients,” Dr. Thomas Frieden, CDC director, told reporters. “Health care facilities are an important part of the solution to drug resistance and every hospital in the country should have a strong antibiotic stewardship program.”
The Problem with Over-Prescribing
The overuse of antibiotics has allowed bacteria to evolve defenses, making some antibiotics useless against strains of bacteria that continue to appear in hospitals across the country. Those strains include C. diff, MRSA, and CRE, which Frieden calls a “nightmare bacteria.”
Acknowledged as a problem by the U.S. Food and Drug Administration (FDA) in 1977, the overuse of antibiotics in livestock and humans is slowly gaining attention.
The new CDC guidelines call for hospitals to commit to antibiotic stewardship with accountability, expertise, action, education, and tracking of antibiotic prescribing practices and hospital infection rates.
With antibiotic treatments tailored to individual patients and close monitoring for 48 hours after therapy begins, Frieden said that it is possible for hospitals to give patients the help they need while safeguarding others against resistant bacteria.
“There’s no conflict between what’s in the best interest of a single patient and what’s in the best interest for patients in general,” he said.
To help move the project forward, the CDC announced that they’ve received a $30 million budget increase to establish the infrastructure needed to detect infection outbreaks and protect the effectiveness of antibiotics.
Dr. Sara Cosgrove, an associate professor of medicine and epidemiology at Johns Hopkins University and chair of the Society for Healthcare Epidemiology of America's Antimicrobial Stewardship Taskforce, said that antibiotics are a precious resource, and the lack of a systematic approach in hospitals has created problems.
“Antimicrobial stewardship programs are a critical step toward stemming the tide of antibiotic resistance and ensuring patients are receiving the right antibiotic, at the right dose and for the right duration,” she said.
Study: Lab Policy Changes Can Reduce Antibiotic Use
To help reduce the unnecessary use of antibiotics, Mount Sinai Hospital in Toronto tried a new and simple approach: don’t routinely report positive urine culture results for patients at a low risk for a urinary tract infection (UTI).
Specifically, the results of urine cultures weren’t auto-forwarded to the ordering physician, but a message was posted in the patient’s electronic records to call the lab should symptoms of a UTI be present.
Often, UTIs are confused with asymptomatic bacteriuria (AB), a common condition that doesn't require antibiotics unless it appears in a pregnant woman.
In the course of the year, antibiotic treatment for AB decreased from 48 percent to 12 percent. Only four UTIs developed in the study group, and each patient was placed on antibiotics based on his or her symptoms, not merely lab results.
Lead study author Dr. Jerome A. Leis of Sunnybrook Health Sciences Centre in Toronto said that there are many examples of cases in which tests are not routinely processed or reported when they’re shown to be associated with potential harm.
“We believe this to be true of some urine cultures from medical and surgical floors where we know that the majority of positive results occur in patients without symptoms of urinary tract infection and lead to unnecessary and potentially harmful therapy with antibiotics,” Leis said in a statement.