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Size Matters in Antibiotic Overuse

Cheryl Clark, for HealthLeaders Media, March 6, 2014

For example, at one of the smallest hospitals in the study, with 68 beds, the average use of antimicrobials per patient day was 1.07, compared with an 804-bed hospital where the average use per patient day was 0.34.

In an e-mail yesterday, one of the poster authors, Ascension pharmacist Roy Guharoy, elaborates:

"Our hypothesis was hospitals with higher acuity (aka case mix index) should use more antibiotics," he writes. "But our findings were different and found that smaller hospitals with lower acuity use more antibiotic than hospitals with higher acuity.

"We also found huge practice variances among the hospitals. The variation may be due to limited resources or lack of expertise or teamwork between the stakeholders."

Guharoy added that the Ascension research documented several factors associated with higher antibiotic use at smaller hospitals:

  • Lack of awareness on judicious antibiotic use
  • Lack of teamwork among pharmacists and physicians
  • Lack of a formal process on appropriate indications for broad spectrum agent use
  • Lack of prospective monitoring on continuation of broad spectrum agent use, such as de-escalation of use after negative result from culture and sensitivity testing
  • Lack of resistance trend monitoring and making appropriate process changes to reduce resistance.

Obama to the Rescue

This is where President Obama's proposed FY2015 budget comes in.

A line item would double the CDC's funding to combat antibiotic resistance, with $30 million per year over five years for the Detect and Protect Against Antibiotic Resistance. The initiative would "identify the sources of emerging infectious diseases faster, determine whether microbes are resistant to antibiotics, and study how microbes are moving through a population."

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