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CDC study finds worrisome trends in hospital antibiotic use

 

Key clinical point: Inpatient antibiotic use did not decrease between 2006 and 2012, and the use of several broad-spectrum agents rose significantly.

Major finding: Hospitals significantly decreased their use of fluoroquinolones and first- and second-generation cephalosporins, but these trends were offset by significant rises in the use of vancomycin, carbapenem, third- and fourth-generation cephalosporins, and β-lactam/β- lactamase inhibitor combinations.

Data source: A retrospective study of administrative hospital discharge data for about 300 US hospitals from 2006 through 2012.

Disclosures: The Centers for Disease Control and Prevention provided funding. The researchers had no disclosures.

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Incorporate behavioral strategies to cut antibiotic overuse

 

The dramatic variation in antibiotic prescribing across individual clinicians, regions in the United States, and internationally indicates great potential for improvement. ... In the article by Baggs et al, inpatient antibiotic prescribing in some regions of the United States is roughly 20% lower than other regions. On a per capita basis, Swedes consume less than half the antibiotics per capita than Americans.

Growing patterns of antibiotic resistance have driven calls for more physician education and new diagnostics. While these efforts may help, it is important to recognize that many emotionally salient factors are driving physicians to inappropriately prescribe antibiotics. Future interventions need to counterbalance these factors using tools from behavioral science to reduce the use of inappropriate antibiotics.

Ateev Mehrotra, MD, MPH, and Jeffrey A. Linder, MD, MPH, are at Harvard University, Boston. They had no disclosures. These comments are from an editorial that accompanied the study ( JAMA Intern Med. 2016 Sept 19. doi: 10.1001/jamainternmed.2016.6254).


 

FROM JAMA INTERNAL MEDICINE

 

U.S. hospitals have not cut overall antibiotic use and have significantly increased the use of several broad-spectrum agents, according to a first-in-kind analysis of national hospital administrative data.

“We identified significant changes in specific antibiotic classes and regional variation that may have important implications for reducing antibiotic-resistant infections,” James Baggs, PhD, and colleagues from the Centers for Disease Control and Prevention, Atlanta, reported in the study, published online on September 19 in JAMA Internal Medicine.

Antibiotic resistance MacXever/Thinkstock
They found that from 2006 through 2012, hospitals significantly decreased their use of fluoroquinolones and first- and second-generation cephalosporins, but these trends were offset by significant rises in the use of vancomycin and broad-spectrum agents used to treat gram-negative infections, including carbapenem, third- and fourth-generation cephalosporins, and β-lactam/β- lactamase inhibitor combinations. Accordingly, they encouraged hospitals to enroll in the Antibiotic Use Option of the National Healthcare Safety Network, adding that surveillance of this type is crucial to prevent and delay the emergence of resistant bacterial pathogens (JAMA Intern Med. 2016 Sept 19. doi: :10.1001/jamainternmed.2016.5651).

The retrospective study included approximately 300 acute care hospitals in the Truven Health MarketScan Hospital Drug Database, which covered 34 million pediatric and adult patient discharges equating to 166 million patient-daysIn all, 55% of patients received at least one antibiotic dose while in the hospital, and for every 1,000 patient-days, 755 days included antibiotic therapy, the investigators said. Overall antibiotic use rose during the study period by only 5.6 average days of therapy per 1,000 patient-days, which was not statistically significant.

However, the use of third and fourth-generation cephalosporins rose by a mean of 10.3 days of therapy per 1,000 patient-days (95% confidence interval, 3.1 to 17.5), and hospitals also used significantly more macrolides (mean rise, 4.8 days of therapy per 1,000 patient-days; 95% confidence interval, 2.0 to 7.6 days), glycopeptides, (22.4; 17.5 to 27.3); β-lactam/β-lactamase inhibitor combinations (18.0; 13.3 to 22.6), carbapenems (7.4; 4.6 to 10.2), and tetracyclines (3.3; 2.0 to 4.7)

Inpatient antibiotic use also varied significantly by region, the investigators said. Hospitals in rural areas used about 16 more days of antibiotic therapy per 1,000 patient-days compared with those in urban areas. Hospitals in Mid-Atlantic states (New Jersey, New York, Pennsylvania) and Pacific Coast states (Alaska, California, Hawaii, Oregon, and Washington) used the least antibiotics (649 and 665 days per 1,000 patient-days, respectively), while Southwest Central states (Arkansas, Louisiana, Oklahoma, and Texas) used the most (823 days).

The CDC provided funding for the study. The researchers had no disclosures.
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