A 1-day survey from the Centers for Disease Control and Prevention finds that among 183 hospitals in the US, 50% of hospitalized patients were given antibiotics, with around half of these receiving two or more. The findings – published in JAMA – may help pinpoint areas of improvement to help tackle antibiotic-resistant infections, the researchers say.
Antibiotic resistance has become a major threat to public health. Each year, antibiotic-resistant infections cause illness in more than 2 million people in the US and lead to around 23,000 deaths.
In a recent Medical News Today spotlight feature discussing the issue, Dr. Steve Solomon, director of the Office of Antimicrobial Resistance at the Centers for Disease Control and Prevention (CDC), told us that antibiotic use at any time in any setting promotes drug resistance.
“When antibiotics are needed to prevent or treat disease, they should always be used,” he added. “But research has shown that as much as 50% of the time, antibiotics are prescribed when they are not needed or they are misused (for example, a patient is given the wrong dose). This inappropriate use of antibiotics unnecessarily promotes antibiotic resistance.”
According to the researchers of this latest study, led by Dr. Shelley S. Magill of the Division of Healthcare Quality Promotion at the CDC, one way to reduce antibiotic resistance is to improve the use of antibiotics.
But in order to do this, it is important to understand the patterns of antibiotic use, particularly in hospital settings where antibiotic-resistant infections are common.
As such, Dr. Magill and her team conducted 1-day prevalence surveys monitoring antibiotic use in 183 hospitals over 10 states in the US between May and September 2011.
- Some infections that are becoming increasingly difficult to treat because of antibiotic resistance include HIV, tuberculosis, malaria and influenza
- In 2011, antibiotic-resistant infections led to an additional 8 million days that people spent in the hospital
- Antibiotic resistance cost the US $20 billion in excess health care costs in 2011.
Overall, 11,282 patients were included in the analysis. Of these patients, 5,635 (49.9%) received at least one antibiotic during the survey, with 32.7% of this group receiving two antibiotics, 12.1% receiving three and 5.4% receiving four or more.
The team found that of the patients who received antibiotics, 4,278 (75.9%) were given them to treat infections. Of this group, 19% received antibiotics for surgical prophylaxis, 6.9% received them for medical prophylaxis, while there were no documented reasons for antibiotic use for 6.9% of these patients.
The researchers say that overall, 83 different antibiotics were administered to treat infections. However, approximately 45% of antibiotic treatment came from only four drugs – parenteral vancomycin, piperacillintazobactam, ceftriaxone and levofloxacin.
These four drugs were the most commonly used antibiotics to treat patients with health care facility-onset infections and patients in critical care units. In addition, these four antibiotics were the most commonly used to treat patients outside of critical care environments and community-onset infections.
What is more, the team found that 54% of antibiotics were used to treat only three types of infection – lower respiratory tract, urinary tract or skin and soft tissue infections.
“Taken together, focusing stewardship efforts on these four drugs and three infection syndromes could address more than half of all inpatient antimicrobial drug use,” say the researchers.
Commenting on their overall findings, the team says:
“Results from this prevalence survey provide patient-level information that augments data on antimicrobial drug consumption and points to specific areas where interventions to improve antimicrobial use may be needed, such as vancomycin prescribing and respiratory infection treatment.
To minimize patient harm and preserve effectiveness, it is imperative to critically examine and improve the ways in which antimicrobial drugs are used. Improving antimicrobial use in hospitals benefits individual patients and also contributes to reducing antimicrobial resistance nationally.”
They add that further research is needed to determine the best settings and circumstances in which to reduce antibiotic use effectively and safely.
Dr. Magill and her team note that their study is subject to some limitations. They point out that because the survey was only conducted in hospitals over 10 states, the generalizability of the results is limited.
Furthermore, they did not gather information on patients’ treatment duration, diagnoses or underlying conditions, so they could not determine whether each patient was given the correct antibiotics. “We are exploring methods to evaluate the quality of antimicrobial prescribing and plan to incorporate these in future investigations,” they add.
MNT recently reported on a study published in The BMJ claiming 1 in 10 antibiotic prescriptions fail.