As health experts battle deadly and seemingly immortal bacteria, a new study shows that hospitals are not doing nearly enough to support antibiotic stewardship.
A new study by researchers with the U.S. Centers for Disease Control and Prevention (CDC) shows just how often some hospital patients are given multiple antibiotics.
According to the study, published in the Journal of the American Medical Association, half of all hospitalized patients receive at least one antimicrobial drug on a given day, most for treating a variety of infections. Half of those patients receive more than one antimicrobial drug, and more than 5 percent take four or more antimicrobial drugs.
The most surprising finding was that of the 83 different antimicrobial drugs used, just four accounted for 45 percent of the treatments. The drugs were most commonly used in patients with hospital-acquired infections and in critical care settings, but also for patients with less serious infections.
Up to 23 percent of the recorded antibiotic use was for infection prevention or had no documented purpose, the study showed.
This is a serious concern for experts because the inappropriate use of antibiotics is tied to more serious drug-resistant infections, as well as adverse drug events. This continued practice — broadly administering important antibiotics — gives bacteria ample opportunity to develop defenses against the drugs.
“To minimize patient harm and preserve effectiveness, it is imperative to critically examine and improve the ways in which antimicrobial drugs are used,” the researchers wrote. “Improving antimicrobial use in hospitals benefits individual patients and also contributes to reducing antimicrobial resistance nationally.”
The CDC researchers stated that if hospitals focused on the four most-used drugs and on reducing the three most common types of infection — lower respiratory tract, urinary tract, and skin and soft tissue infections — they could address more than half of all inpatient antibiotic use.
The CDC researchers reached their conclusions by using data from 11,282 patients in a one-day snapshot of 183 acute care hospitals in 10 states.
Antibiotics, the hallmark of modern medicine, are rapidly losing their effectiveness, and health experts are clamoring for ways to slow the epidemic.
Antibiotic-resistant bacteria are a major worldwide health threat. In its first report on antibiotic resistance, the
In the United States, drug-resistant bacteria are responsible for at least 23,000 deaths per year and another 2 million illnesses. These infections can result in amputated limbs, gut resectioning, or lasting scars from skin infections.
In April, Dr. Keiji Fukuda, the WHO’s assistant director-general for Health Security, offered a grim assessment of the situation: without coordinated effort, the world is headed into a post-antibiotic era.
“Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe, and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating,” Fukuda said.
One of the key ways doctors can slow the epidemic is by only prescribing and dispensing antibiotics when they are truly needed, as well as by prescribing the appropriate drugs to treat a given infection.
But not all of the blame falls on doctors. Too often, patients demand antibiotics, leaving doctors at a crossroads between providing good customer service and using their best medical judgment.
To take the guesswork out of prescribing, experts, including the President’s Council of Advisors on Science and Technology, recommend the expanded use of rapid diagnostic tests, which would give doctors quick access to lab results to match antibiotics to the appropriate infection.
Experts agree: stopping superbugs will take a concerted effort.
“With the growing development of antibiotic resistance, it is imperative that we no longer take the availability of effective antibiotics for granted,” CDC director Dr. Tom Frieden testified before Congress earlier this year. “As a nation, we must respond to this growing problem, and our response needs to be multifactorial and multidisciplinary.”
Patients can take several steps to help fight drug resistance. The WHO recommends:
- only taking antibiotics when prescribed by a doctor
- never sharing antibiotics with another person
- taking the full course of antibiotics, even if you feel better