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Vital Signs: Improving Antibiotic Use Among Hospitalized Patients

Having trouble viewing this email? View it as a Web page.   MMWR Early Release Vol. 63, Early Release March 4, 2014   PDF

Vital Signs: Improving Antibiotic Use Among Hospitalized Patients 
Scott Fridkin, MD, James Baggs, PhD, Ryan Fagan, MD, et al.
MMWR 2014;63:1–7 

When antibiotics are prescribed incorrectly, they offer little benefit to patients and potentially expose them to risks for complications, including Clostridium difficile infection and antibiotic-resistant infections. This report describes a study that found that 55.7% of patients discharged from 323 hospitals in 2010 had received antibiotics during their hospitalization, but antibiotic prescribing potentially could be improved in 37.2% of the most common prescription scenarios.

Vital Signs: Improving Antibiotic Use Among Hospitalized Patients

Early Release

March 4, 2014 / 63(Early Release);1-7

Scott Fridkin, MD1, James Baggs, PhD1, Ryan Fagan, MD1, Shelley Magill, MD, PhD1, Lori A. Pollack, MD1, Paul Malpiedi, MPH1, Rachel Slayton, PhD1, Karim Khader, PhD2 Michael A. Rubin, MD, PhD2, Makoto Jones, MD1, Matthew H. Samore, MD2, Ghinwa Dumyati, MD3, Elizabeth Dodds-Ashley, PharmD3, James Meek, MPH4, Kimberly Yousey-Hindes, MPH4, John Jernigan, MD1, Nadine Shehab, PharmD1, Rosa Herrera1, L. Clifford McDonald, MD1, Amy Schneider, MPH1, Arjun Srinivasan, MD1 (Author affiliations at end of text)

Background: Antibiotics are essential to effectively treat many hospitalized patients. However, when antibiotics are prescribed incorrectly, they offer little benefit to patients and potentially expose them to risks for complications, including Clostridium difficile infection (CDI) and antibiotic-resistant infections. Information is needed on the frequency of incorrect prescribing in hospitals and how improved prescribing will benefit patients.

Methods: A national administrative database (MarketScan Hospital Drug Database) and CDC's Emerging Infections Program (EIP) data were analyzed to assess the potential for improvement of inpatient antibiotic prescribing. Variability in days of therapy for selected antibiotics reported to the National Healthcare Safety Network (NHSN) antimicrobial use option was computed. The impact of reducing inpatient antibiotic exposure on incidence of CDI was modeled using data from two U.S. hospitals.

Results: In 2010, 55.7% of patients discharged from 323 hospitals received antibiotics during their hospitalization. EIP reviewed patients' records from 183 hospitals to describe inpatient antibiotic use; antibiotic prescribing potentially could be improved in 37.2% of the most common prescription scenarios reviewed. There were threefold differences in usage rates among 26 medical/surgical wards reporting to NHSN. Models estimate that the total direct and indirect effects from a 30% reduction in use of broad-spectrum antibiotics will result in a 26% reduction in CDI.

Conclusions: Antibiotic prescribing for inpatients is common, and there is ample opportunity to improve use and patient safety by reducing incorrect antibiotic prescribing.

Implications for Public Health: Hospital administrators and health-care providers can reduce potential harm and risk for antibiotic resistance by implementing formal programs to improve antibiotic prescribing in hospitals.

Introduction

Antibiotics offer tremendous benefit to patients with infectious diseases and are commonly administered to patients cared for in U.S. hospitals. However, studies have demonstrated that treatment indication, choice of agent, or duration of therapy can be incorrect in up to 50% of the instances in which antibiotics are prescribed (1). One study reported that 30% of antibiotics received by hospitalized adult patients, outside of critical care, were unnecessary; antibiotics often were used for longer than recommended durations or for treatment of colonizing or contaminating microorganisms (2).

Incorrect prescribing of antibiotics exposes individual patients to potential complications of antibiotic therapy, without any therapeutic benefit. One such complication is infection with Clostridium difficile, an anaerobic, spore-forming bacillus that causes pseudomembranous colitis, manifesting as diarrhea that often recurs and can progress to sepsis and death; CDC has estimated that there are about 250,000 C. difficile infections (CDI) in hospitalized patients each year (3). Other complications related to unnecessary use of antibiotics include infection with antibiotic-resistant bacteria (4) and complications from adverse events (5).

Evidence is accumulating that interventions to optimize inpatient antibiotic prescribing can improve patient outcomes (6). To assist health-care providers to reduce incorrect inpatient prescribing, information is needed regarding how frequently incorrect prescribing occurs in hospitals and how improving prescribing will benefit patients. In this report, current assessments of the scope of inpatient antibiotic prescribing, the potential for optimizing prescribing, and the potential benefits to patients are described.