Reducing Antibiotic Use in Hospitals to Reduce Antibiotic Resistance

Informational poster from the CDC.

A federal report issued by the Centers for Disease Control and Prevention (CDC) indicates that extensive prescribing of antibiotics is at least partially responsible for the development of C. diff (Clostridium difficile), an antibiotic-resistant bacterial infection also known as a superbug.

C. diff infections affect about 250,000 patients every year and it is very difficult, if not impossible to treat because it has evolved to be resistant to treatment with antibiotics. The infection can reoccur and can include spore-forming colitis, diarrhea, sepsis and death. Symptoms include nausea, fever, diarrhea, loss of appetite and abdominal pain. The bacterium is shed in the feces and can reinfect patients through hand contact or contact with an infected surface.

In its Morbidity and Mortality Weekly Report (MMWR), researchers with the CDC antibiotic stewardship program gathered data from the CDC’s Emerging Infections Program and the MarketScan Hospital Drug Database.

Looking at 2010, 55.7 percent of patients discharged from 323 hospitals were prescribed antibiotics during their hospital stay. Of that group, at least 30 percent had received a dose of broad-spectrum antibiotics. The data suggests that antibiotic prescribing in hospitals is very common and often done too frequently.

A reduction by 30 percent of broad-spectrum antibiotics would prevent about 26 percent of C. diff cases, according to the CDC.

Some hospitals, it was found, prescribe about three times the amount of antibiotics as other hospitals. Because of the wide treatment variables among hospitals, patients are being put at an unnecessary risk of acquiring these drug-resistant infections, according to the report in Vital Signs.

The CDC suggests if hospitals follow a seven-step checklist so prescriptions and the resulting drug-resistant bacterial infections can be better tracked. State and local health departments are encouraged to reduce antibiotic use and the CDC urges doctors to test a patient before beginning a regimen of antibiotics to make sure the drug is necessary. Doctors are encouraged to follow-up two days later to make sure the prescription is working. If the particular bacterial infection has already developed immunity to the drug, it will not work and the course of antibiotics will be useless.

Part of the CDC initiative will be to expand the tracking of infections nationwide through the National Healthcare Safety Network. The American Hospital Administration (AHA) is involved in this initiative and will release to hospitals resources to safely reduce the use of antibiotics.

C. diff is reported to kill about 14,000 Americans annually, especially those with compromised immune systems.