Hospitals are falling short of meeting national targets to reduce inappropriate antibiotic prescribing despite efforts in recent years to bolster stewardship, according to new research.
An evaluation of antibiotic use in hospitals conducted by the Centers for Disease Control and Prevention found 56% of antibiotic prescriptions were inappropriate in terms of the type of drug used, the duration they were prescribed, or the medical conditions for which they were given.
The analysis, published Thursday in the journal JAMA Network Open, examined antibiotic prescriptions given to more than 1,500 patients at nearly 200 hospitals between May 1 and Sept. 30 of 2015.
Community-acquired pneumonia and urinary tract infections were the most common health conditions for which antibiotics were inappropriately prescribed. Researchers found 79% of antibiotic prescriptions for pneumonia fell outside of recommended practices guidelines, while 77% of antibiotic prescriptions written for UTIs were deemed unnecessary.
CDC estimates more than 2.8 million antibiotic-resistant infections occur in the United States each year, resulting in more than 35,000 deaths.
Inappropriate antibiotic has been the largest contributor to the spread of antimicrobial-resistant pathogens. The CDC estimates 47 million, or 30%, of all antibiotic prescriptions written each year are given to treat for infections that don't need antibiotics.
A study released earlier this month by the Pew Charitable Trusts found more than half of patients hospitalized due to COVID-19 during the first six months of the pandemic received an antibiotic.
Over the past several years, both government regulators and medical accreditation organizations have launched initiatives seeking to improve hospital antibiotic stewardship.
In 2017, the Joint Commission issued a set of standards for acute-care hospitals, critical access hospitals and nursing homes to establish an antibiotic stewardship program as a condition of maintaining their accreditation. In September 2019, CMS finalized a rule that required all hospitals to have an antibiotic stewardship program.
Such initiatives have led to a stark increase in hospital antibiotic stewardship programs, going from less than 40% in 2014 to an estimated 89% of acute-care facilities by 2019.
Yet the latest findings from the JAMA study points to a need for hospitals to focus more on improving the quality, and not just the quantity of antibiotic stewardship programs.
"The report really underscores a need for good antibiotic stewardship programs being established in hospitals," said study co-author Dr. David Hyun, antibiotic resistance project director for the Pew Charitable Trusts. "It's important to ensure that these stewardship programs are conducting meaningful activities that really impacts the quality of antibiotic prescribing."
In a separate analysis released Thursday, Pew set a national target for hospitals to improve their antibiotic stewardship efforts, antibiotics, calling for hospitals to reduce inappropriate antibiotic prescribing for both pneumonia and UTIs by 90%.
Hyun felt the federal government could play an important role in furthering hospitals' efforts to improve antibiotic stewardship by offering smaller and more rural facilities have greater access to the technical supports they need to help more of them build up their stewardship programs.
"That's an area where the federal government can have a role in helping antibiotic stewardship programs achieve meaningful outcomes," Hyun said.
