Vital signs: improving antibiotic use among hospitalized patients

Abstract

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.

FIGURE 1

Percentage of hospital discharges with at least one antibiotic day, by antibiotic group — 323 hospitals, United States, 2010* * Data provided by Truven Health MarketScan Hospital Drug Database. ^† Antibiotics from these three groups, which are considered to place patients at high risk for developing Clostridium difficile infection, were administered to 29.8% of the patients.

FIGURE 2

Rate of antibiotic use, by antibiotic group, class, or specific agent, among medical and surgical patients in 26 wards at 19 acute care hospitals — National Healthcare Safety Network Antimicrobial Use Option, October 2012–June 2013* * Horizontal lines represent median, 10th and 90th percentile values; whisker points are the minimum and maximum values. Plus sign is the mean value. ^† Including fluoroquinolones, β-lactam/β-lactamase inhibitor combinations, and 3rd and 4th generation cephalosporins.