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Antibiotics are precious and increasingly scarce. ... We are depleting the effectiveness of the antibiotics we have today.
Antibiotics are precious and increasingly scarce. ... We are depleting the effectiveness of the antibiotics we have today.

Resistance movement

Hospital administrators must join the fight against antibiotic overuse

By Eili Klein and Ramanan Laxminarayan
Posted: August 4, 2012 - 12:01 am ET

Research published July 2 by our organization, Extending the Cure, shows a troubling, seasonal rise in antibiotic resistance—one that adds urgency to hospital efforts to combat the problem of resistance and resistant infections that can spread easily from patient to patient.

The report, in the journal Clinical Infectious Diseases, suggests that resistance can develop rapidly and is correlated with periods of intensive antibiotic use—during flu season, for example. The study shows that hospitals get hit with a wave of resistant infections just weeks after sales of antibiotics in the surrounding community go up.

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Those findings confirm that antibiotic selection pressure in any one setting—the community in this case—has the potential to increase drug resistance in other settings, such as in hospitals.

The emergence and spread of resistant microorganisms are intrinsically linked to the way we use and prescribe antibiotics. Every time a healthcare provider writes a prescription for an antibiotic for the flu or another viral infection it cannot cure, we quicken the pace to a future in which we will no longer be able to rely on antibiotics as treatments for common infections.

Research from Extending the Cure, a research and consultative effort funded in part by the Robert Wood Johnson Foundation, suggests that more hospitals are adopting antimicrobial stewardship programs to curb antibiotic overuse and keep drug-resistant infections at bay.

But this study, which looks at the correlation between antibiotics prescribed in the community and resistance in hospitals, showed that hospitals can do all the right things in terms of infection control and stewardship, yet still lose the battle to keep people safe from “superbugs,” resistant microorganisms that can cause potentially deadly infections. Without stewardship programs that span hospital and community settings, hospitals will continue to see seasonal fluctuations in resistance.

Eili Klien, Extending the Cure
According to the new research, spikes in prescription sales for two popular classes of antibiotics during flu season led to a rapid increase, one month later, in resistant Escherichia coli, or E. coli, in hospitals. This superbug can cause potentially serious urinary tract and other infections that can lengthen hospital stays and drive up the cost of care.

The study also showed that increases in prescriptions during flu season for two other classes of antibiotics were linked to a rise in methicillin-resistant Staphylococcus aureus, or MRSA, a superbug that kills about 19,000 people annually, according to the Centers for Disease Control and Prevention.

People suffering from the flu often ask for, and get, an antibiotic, even though these drugs cannot kill the influenza virus—or any virus. Research by Extending the Cure suggests that up to 1 million unnecessary antibiotic prescriptions are written during flu season.

Hospital- and other healthcare-associated infections, including those resistant to antibiotics, now account for nearly 2 million illnesses and kill about 99,000 people annually in the U.S. In addition to the lives lost, such infections are responsible for $20 billion in excess healthcare costs, including those shouldered by hospitals.

What can we do?

Many hospitals already have inpatient stewardship programs to encourage the use of antibiotics only when indicated. They also have infection-control measures in place to curb the spread of resistant infections from one hospital patient to the next. However, those efforts alone will not be enough.

Ramanan Laxminarayan, director of Extending the Cure
Administrators and public health officials can and should do more by coordinating local and regional educational campaigns—involving doctors and other partners—to curtail unnecessary antibiotic use, whether it occurs in the intensive-care unit or in a doctor's office.

In addition, they must encourage all Americans, including doctors and other hospital employees, to get an annual flu shot. Fewer people suffering from the flu would translate to fewer unnecessary antibiotic prescriptions in the winter.

We all must play a part in the effort to sustain the power of the antibiotics we have on hand today to fight infections. Consumers can resist the urge to demand an antibiotic at the first sign of the flu or a common cold.

But hospital administrators can also use their role as community leaders and health educators to encourage wiser use of antibiotics—drugs that one by one will become useless if we do not stop their inappropriate use.

Antibiotics are a precious and increasingly scarce natural resource. Just as we are depleting oil or groundwater supplies, we are also depleting the effectiveness of the antibiotics that we have on the shelf today. New antibiotics are hard to come by and expensive compared with current ones.

Hospital administrators must push physicians and patients alike to think twice before jumping to the “fast fix” offered by antibiotics, especially during flu season. With more judicious use of antibiotics both inside the hospital and out in the community, we can continue to count on these drugs for fast and reliable cures.

Eili Klein is a fellow and Ramanan Laxminarayan is the director of Extending the Cure.

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