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Antibiotic prescription rates vary widely in U.S. hospitals


By Sabriya Rice
Posted: March 4, 2014 - 4:45 pm ET
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Doctors in some hospitals may prescribe three times as many antibiotics as doctors in other hospitals for patients receiving the same type of care, finds a new CDC Vital Signs Report. The variability is a major concern, health officials say. They are sounding a warning bell once again about the overuse of antibiotics, asking physicians to re-evaluate how they prescribe the drugs.

Experts were surprised by the wide variability in the report of how frequently antibiotics were prescribed. Although the drugs can be lifesaving for certain patients, overuse of antibiotics can lead to antimicrobial resistance, one of the nation's most serious health threats. With some pathogens resistant to multiple types of antibiotics, treating patients with these types of infectious diseases is becoming increasingly more difficult.

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The report found many patients were given antibiotics even though they had not undergone the proper testing, and many others received a prescription for a time period that was longer than recommended. A 30% reduction in prescriptions for the antibiotics that are most likely to cause C. difficile infections can reduce their spread by more than 25%, according to the analysis. The problem of hospital-acquired infections and drug resistance was included in the proposed budget released Tuesday by the Obama administration, which allocates $30 million annually for the next five years to help identify emerging threats, and boost prevention, detection and testing for such infections. Healthcare facilities are an important part of that solution, emphasized

Dr. Tom Frieden, the CDC director, during the Centers for Disease Control and Prevention news conference. “Improving antibiotic prescribing can save today's patients from deadly infections and protect lifesaving antibiotics for tomorrow's patients,” Frieden said. He was joined by Dr. Arjun Srinivasan, a medical epidemiologist with the CDC, and Dr. John Combes, a senior vice president of the American Hospital Association, in sharing the results and releasing new materials that can be used by physicians and hospitals. Every hospital in the country, they recommend, should have strong antibiotic stewardship programs that include: commitment from hospital leadership; a physician who can act as an accountability leader; regular reporting on antibiotic use; and a way of monitoring prescribing and resistance patterns. Seven core stewardship element recommendations are outlined in a checklist posted today on the CDC's website. The issue of interfacility transmissions also is addressed. “Patients are mobile,” said Frieden, who warned that a drug-resistant organism can easily land at the door of another facility. The use of patient-transfer forms to inform a receiving facility about an infection was encouraged. Experts also outlined three key steps for physicians (PDF), including ordering cultures before giving antibiotics, making sure the dose and indication are clearly specified in the patient's record, and reassessing the prescription within 48 hours. “We're not saying don't use them (antibiotics), we're saying to assess them systematically,” Frieden noted. Hospitals that have implemented such strategies have saved between $200,000 and $900,000 annually, depending on the size and the extent of the intervention, the Vital Signs Report found. If others follow these best practices, “nightmare bacterial infections” can be dramatically reduced, Frieden said. “One of the things that makes us so focused on antimicrobial resistance, is that it's a serious problem but it's not too late.” Follow Sabriya Rice on Twitter: @MHsrice


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