Antibiotics Prescribed to Majority of Hospitalized Patients

A CDC report also finds that reducing the rate of broad-spectrum antibiotic use in hospitalized patients could have a substantial impact on the rate of Clostridium difficile infection.

More than half of all hospital patients are prescribed antibiotics at some point during their stay, according to a report published in the March 7, 2014, issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. The report also notes that models find that reducing the use of broad-spectrum antibiotics among hospitalized adults would result in a substantial reduction in Clostridium difficile infections.

The researchers analyzed the Truven Health MarketScan Hospital Drug Database and data from the CDC’s Emerging Infections Program to determine the prevalence and reasons for antibiotic prescribing in acute care hospitals throughout the country. They studied additional data reported from October 2012 to June 2013 to the National Healthcare Safety Network Antimicrobial Use Option to estimate the potential for improving antibiotic prescribing for urinary tract infections and for prescribing of intravenous vancomycin. The researchers also included results from a study in 2 large hospitals to calculate reductions in C difficile infections that could occur with improved use of antibiotics.

Data from the MarketScan database indicated that in 2010, 55.7% of inpatients at 323 hospitals across the country were given antibiotics during their time spent in the hospital, and 29.8% received at least 1 dose of broad-spectrum antibiotics. Of the 11,282 patients evaluated in 2011 by the Emerging Infections Program, 37.1% received at least 1 antibiotic to treat an active infection; 49.9% of these antibiotics were prescribed to treat lower respiratory, urinary tract, or presumed resistant Gram-positive infections.

Based on data from 36 hospitals, the report also found that antibiotic prescribing could potentially have been improved in 37.2% of the specific prescription scenarios reviewed. Most of these improvements would involve better use of diagnostic testing. When analyzed by hospital type, combined medical and surgical wards varied the most in their antibiotic use, with some prescribing antibiotics at 3 times the rate of others.

A model accounting for direct and indirect effects of changes in antibiotic use suggested that the rate of C difficile infections would decrease by 26% if broad-spectrum antibiotic use among hospitalized patients were reduced by 30%. This reduction in broad-spectrum antibiotic use would translate to an approximate 5% reduction in the overall portion of hospitalized patients receiving any antibiotic.

These results are consistent with previous studies that have found antibiotic use to be common and often incorrect in hospitals.

“Given the proven benefit of hospital stewardship programs to patients and the urgent need to address the growing problem of antibiotic resistance, CDC recommends that all hospitals implement an antibiotic stewardship program,” the report notes.

The CDC has developed guidance materials and a stewardship assessment tool to help hospitals launch or improve stewardship programs.