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CDC report highlights issues with antibiotic provision

Wednesday March 5, 2014
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Clinicians in some hospitals prescribe three times as many antibiotics as clinicians in other hospitals, even for patients who receive care in similar areas of each hospital, according to a CDC report.

“Although some of these differences might be attributable to differences in the mix of patients within these similar patient care locations, it is likely some might be explained by differences in prescribing practices,” the researchers wrote.

In addition, prescribing practices to treat urinary tract infections and prescriptions for vancomycin included a potential error in 37% of cases, the researchers reported in the March issue of Vital Signs. Potential errors included provision of an antibiotic without proper testing or evaluation or for too long a duration.

The report also found that a 30% reduction in hospitals’ use of broad-spectrum antibiotics can reduce Clostridium difficile infections by 26%. The same antibiotics also prime patients for future super-resistant infections, the researchers noted. “Some hospitalized patients now have infections for which there are no available antibiotic treatments. Urgent action is required to address this growing public health crisis. Improving the prescribing of antibiotics in hospitals is one important part of a broader strategy to counter the increase in antibiotic resistance.”

“Improving antibiotic prescribing can save today’s patients from deadly infections and protect lifesaving antibiotics for tomorrow’s patients,” CDC Director Tom Frieden, MD, MPH, said in a news release. “Healthcare facilities are an important part of the solution to drug resistance and every hospital in the country should have a strong antibiotic stewardship program.”

More than half of all hospitalized patients will receive an antibiotic at some point during their hospital stay. The Vital Signs report showed that the most common types of infections for which hospital clinicians write prescriptions are urinary tract infections, lung infections and suspected infections caused by drug-resistant Staphylococcus bacteria, such as MRSA.

To help hospitals, whether large or small, develop antibiotic stewardship programs, the CDC released practical tools that include seven key elements, a self-assessment checklist and an in-depth implementation document.

Through the National Healthcare Safety Network, the nation’s most widely used healthcare-associated infection tracking system, the CDC is working to provide facilities, states, regions and the nation with data needed to identify problem areas, measure progress of prevention efforts and ultimately eliminate healthcare-associated infections.

“Today’s antibiotics are miracle drugs, but they are endangered,” Arjun Srinivasan, MD, the CDC’s medical epidemiologist, said in the news release. “These new materials provide core elements and practical tools for beginning and advancing antibiotic stewardship programs.”

Antibiotic prescription checklist

Every hospital should implement a stewardship program that includes seven core elements, according to the CDC:

Leadership commitment: Dedicate the necessary human, financial and IT resources.

Accountability: Appoint a single leader responsible for program outcomes.

Drug expertise: Appoint a single pharmacist leader to support improved prescribing.

Act: Take at least one prescribing improvement action, such as requiring reassessment of prescriptions within 48 hours to check drug choice, dose and duration.

Track: Monitor prescribing and antibiotic resistance patterns.

Report: Regularly report prescribing and resistance information to clinicians.

Educate: Offer education about antibiotic resistance and improving prescribing practices.

Working with other healthcare facilities in the area to prevent infections, transmission and resistance also is critical, according to the CDC.

Vital Signs report: www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0304a1.htm

2013 CDC report on antibiotic resistance: www.cdc.gov/drugresistance/threat-report-2013

2013 Get Smart About Antibiotics Week: http://www.cdc.gov/getsmart/


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