Hospital Antibiotic Prescribing Could be Significantly Improved

A recent study on antibiotic use in hospitalized patients found that antibiotic prescribing could potentially be improved in more than one-third of the most common prescription scenarios [MMWR. 2014;63(9):194-200]. This study also found that reduction of the use of broad-spectrum antibiotics could result in a significant reduction in Clostridium difficile infection (CDI) among patients.

Antibiotics are routinely administered in hospitals and are often essential to patient care, but recent studies have also found that they may be incorrectly prescribed in up to 50% of the instances. According to the report, the incorrect use of prescriptions not only offers little benefits to patients, but it can also put patients at risk for complications, such as CDI and the development of antibiotic-resistant infections.

“This is a particularly problematic bug that causes inflammation in the intestinal tract, causes sometimes mild diarrhea, but often quite severe [diarrhea], requiring at times colectomy...and has even been associated with death, especially in very old [patients] or in patients with very weakened immune systems,” said Scott Fridkin, MD, lead author of the study, senior advisor, antibiotic resistance in healthcare, division of healthcare quality promotion, Centers for Disease Control and Prevention (CDC), in an interview with First Report Managed Care.

This latest report assesses inpatient antibiotic prescribing, the impact that improved prescribing practices could potentially have on the industry, and the benefit to patients. To determine the potential for improvement in prescribing habits, researchers used data from the Truven Health MarketScan Hospital Drug Database and the CDC Emerging Infections program (EIP).

The researchers also used data from the EIP and the National Healthcare Safety Network Antimicrobial Use Option to highlight the improvement potential for changing antibiotic prescription patterns for specific diagnoses and scenarios, such as in the case of a urinary tract infection (UTI). Finally, researchers used data from 2 US hospitals to model how reducing inpatient antibiotics could affect the incidents of CDI.

The researchers found that, during 2010, 55.7% of patients discharged from 323 hospitals had been given antibiotics during their hospital stay. In addition, they reported that 29.8% of patients had received at least 1 dose of broad-spectrum antibiotics.

When using the EIP data, they reported that, in 2011, 37.1% of patients in 183 hospitals received at least 1 antibiotic to treat an active infection. In addition, the most common treatment scenarios (49%) were related to lower respiratory infections, UTIs, or presumed resistant Gram-positive infections.

The researchers also took a closer look at several specific scenarios where antibiotics are often prescribed. To do this, they looked at a sample of 36 hospitals across 8 different EIP sites and assessed data related to UTIs in patients without indwelling catheters and treatment with intravenous vancomycin. Overall, they determined that in 37.2% of the cases, antibiotic use could have potentially been improved.

The report also addressed the impact improved antibiotic prescribing could have specifically on CDI. The authors found, using mathematical modeling that included both direct and indirect effects, that a 30% reduction in exposure to broad-spectrum antibiotics, which translates to a 5% reduction in overall antibiotic use, could result in a 26% decrease in CDI.

“Probably the biggest implication of the study is that the evidence here illustrates that antibiotics are used a lot in hospitals, they are often not used correctly or as appropriately as they can be, and that excessive use of antibiotics has bad consequences for patients,” said Dr. Fridkin. “There are tremendous benefits for improving the use of antibiotics in the hospital setting.”

He said the CDC recommends that all hospitals establish an antibiotic stewardship to help address some of the concerns related to antibiotic use in hospital settings.