Hospital physicians who overprescribe antibiotics are putting patients "at unnecessary risk of future drug-resistant infections, allergic reactions, and intestinal infections that can be deadly," a Centers for Disease Control and Prevention official says.
Hospital physicians are putting their current and future patients in danger by overusing antibiotics, and they need to take steps now to prevent resistant bacterial strains, Centers for Disease Control and Prevention officials warned Tuesday.
According to a CDC survey, "about half of hospitalized patients got antibiotics during their stay." But "given the many reasons patients need hospital care, that's not particularly surprising," agency director Tom Frieden, MD, said during a news conference.
"What did really surprise me is that doctors in some hospitals prescribed three times as many antibiotics as others even though the patients were being cared for in similar areas of each hospital," Frieden said.
The White House budget proposal, also released Tuesday, calls for $30 million per year for five years to combat antibiotic-resistant infections. The money is meant to help hospitals more rapidly identify and treat "superbugs."
Prescribing Errors
For one-third of the patients, prescribing practices to treat urinary tract infections and one-third of the orders for one broad spectrum antibiotic vancomycin contained potential errors. Those errors included giving patients antibiotics without appropriate testing to match their bacterial infection with the drug, or giving patients the drugs for too long.
Frieden made his remarks during a news conference as the agency launched this month's Vital Signs, a special Morbidity and Mortality Weekly Report intended to "sound the alarm about health threats." He said the issue is one with a "huge impact on patient safety."
The survey, which was conducted in 2010, used data from the CDC's national Hospital Drug Database (HDD) collected from a representative sample of medical surgical units at 323 hospitals, and data from the agency's Emerging Infections Program (EIP), a network of state health departments and academic institutions to take a snapshot of antibiotic appropriateness in 183 hospitals.
More than half (55.7%) of patients discharged from those 323 hospitals received antibiotics and antibiotic use could potentially have been improved for 37.2% of the patients who received them, the survey results concluded.
And if hospitals could reduce the use of antibiotics by just 30%, they could see a 26% reduction in C. diff infections, Frieden said.
7 'Critical Components' Identified
The agency is calling for every hospital in the country to launch a focused antibiotic stewardship program and implement seven "critical components" to improve its antibiotic practices to "help us all step back from the brink" of not having effective antibiotics because emerging bacterial mutations have make the drugs ineffective. The seven components are:
- Commitment to the program with the necessary number of people, money, and information technology.
- Accountability, with a single responsible leader. Frieden said that physicians have "proven very successful in this role."
- Drug expertise, with a single pharmacist leader to support improved prescribing.
- Action, with each hospital taking at least one action to improve prescribing, such as an automatic reassessment or "pause on antibiotic prescriptions within 48 hours to make sure the drug choice is appropriate, that maybe it can be narrowed or tailored, that the dosage is appropriate, and looking at the duration."
- Tracking and monitoring antibiotic resistance patterns from the hospital.
- Reporting regularly to hospitals prescribing resistant patterns, and steps that they can take to improve practices.
- Education about antibiotic resistance to improve prescribing practices.
Frieden added that the CDC wants hospitals to work with local and state health departments and other health facilities. "Resistant bacteria in any facility can easily land at the door of any other facility in the community," he said.
For doctors and nurses, the CDC asks for three actions.
- Order recommended cultures before antibiotics are given and start treatment promptly.
- Make sure the indication, dose and expected duration are specified in the patient record.
- Reassess within 48 hours to adjust or stop the prescription as appropriate.
Frieden was joined by American Hospital Association senior vice president John Combes, MD, who said that hospitals "recognize we must improve our practices. Not only for the benefit of the patients under our care, but also to preserve the effectiveness of antibiotics for future patients."
Debunking a Myth
Frieden added that clinicians may think they're giving their patients the best care possible, but poor or lack of antibiotic stewardship programs put patients "at unnecessary risk of future drug-resistant infections, allergic reactions, and intestinal infections that can be deadly from Clostridium difficile."
The CDC director said that he wanted to "debunk" a myth that he has heard "in some quarters" that doctors want to give their patients the best medicine even if it's bad for other patients because it protects their own patients.
"That's actually not the case," Frieden says. "In fact, what we're finding…is that by giving your patients the best possible treatment, and that means the treatment that's tailored to their infection…not only do you protect them against a super-resistant organism or C. difficile diarrhea, but you also protect other people in the hospital and the community."
"As an infectious disease doctor myself, I recall patients I've treated who've run out of antibiotics, and I don't want to see that kind of situation spread in this country."
More CDC information about healthcare efforts to promote antibiotic stewardship is here.