Curbing inappropriate use of antibiotics in hospitals could greatly reduce potentially fatal bacterial infection and help stem a tide of antibiotic resistance threatening the current drug supply, the director of the Centers for Disease Control and Prevention said Tuesday.
In its monthly Vital Signs report on important public health issues, the CDC said hospitals should take more steps to discourage inappropriate use of the drugs.
In 2010, 55.7 percent of all hospital patients got an antibiotic during their stay but up to 50 percent of the time those drugs were prescribed incorrectly, either with the wrong drug or the wrong duration or for the wrong condition, the report noted.
One result of overuse or misuse of antibiotics is a particularly nasty bacterial infection called Clostridium difficile, which can cause diarrhea and even death. There are about 250,000 such cases a year, the report notes.
If the use of broad spectrum antibiotics were reduced by 30 percent, the number of such bacterial cases would be reduced by 26 percent, the report said.
“That’s almost a one to one impact, a huge impact on patient safety,” said Dr. Thomas Frieden, director of the CDC.
Even worse, the use of a broad spectrum antibiotic put those patients at nearly three times higher risk of getting that bacterial infection within six months, the report noted.
“While these drugs are often life-saving, prescribing them when they are not needed or for the wrong duration, fuels resistance and can set patients up for more drug-resistant infections in the future,” Frieden said. And that is the ultimate fear of physicians – running into infections resistant to all the drugs they have, he said.
“As an infectious disease doctor myself, I recall patients I’ve treated who’ve run out of antibiotics (that work) and I don’t want to see that kind of situation spread in this country,” Frieden said.
Nearly every hospital now has an antibiotic stewardship program to monitor their use. Georgia Regents Medical Center took the additional step of having a specific pharmacist for those drugs to monitor their use, said Dr. Jose Vazquez, chief of infectious disease. As Vazquez was talking on the phone, the antibiotic pharmacist came into his office and asked him to consult on an unusual case.
“We see these patients on a daily basis as part of the stewardship program,” Vazquez said.
The hospital is hoping to take that further with a system that will allow the microbiology lab to communicate in real-time with the pharmacists and infection control to spot and track infections and overuse, Vazquez said.
In addition, every patient sent home on IV antibiotics must go before the antibiotic stewardship committee to review for appropriateness, he said. Half the time, those patients could actually get oral drugs and often the IV is the wrong drug anyway, Vazquez said.
That is important because “these people are going into the community so that means we risk spreading these multidrug resistant organisms in the community,” he said. Vazquez knows that firsthand, having picked up the c. difficile infection while in the community caring for a loved one,
And even though his was a mild case, “it was horrific,” he said.