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Size Matters in Antibiotic Overuse

Cheryl Clark, for HealthLeaders Media, March 6, 2014

The initiative has a special effort to help hospitals and other healthcare facilities, including small rural hospitals, by establishing a five-region resistance laboratory network, says Abbigail Tumpey, associate director for the CDC's Communications Science.

The idea is that these labs would have "reference" capable technology similar to the gold standard equipment the CDC has, so the hospital could much more quickly find out what drug the patient's bacteria might be susceptible to. Tumpey says that most hospitals' labs "do not have every antibiotic drug included in their susceptibility panels."

In some cases, "the hospital may not be sure what type of resistance the patient has" unless it sends the sample back to the CDC, she says.

The budget proposal include funding for prevention collaboratives to stimulate cooperative efforts in communities to track resistant strains of bacteria, for example within nursing homes, long-term care facilities, and hospitals.

Problematic Prescribing Practices

Srinivasan emphasizes that the issue of hospital practices is complicated. "There's a lot we still have to learn about what underlies this variation," he says.

But the CDC is narrowing in on where the problem lies within hospital workflows. There are two major weaknesses, he says.

First, many clinicians fail to order cultures to properly identify a bacterial infection, which would enable them to prescribe an effectively targeted antibiotic. "There's obvious room for improvement there," he says.

What too often happens is that doctors start vancomycin because "they're worried a patient has a methicillin-resistant staph aureus infection or MRSA. However, recommendations are that if you don't recover MRSA from the culture results, that's a good indication the patient does not have MRSA, and many experts would say that's a good time to stop therapy with vancomycin.

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