Wednesday, March 05, 2014

CDC: Improving Antibiotic Prescribing Practices In Hospitals



# 8349



On Monday, in CDC Telebriefing (March 4th): Improving Antibiotic Prescribing Practices, I wrote about an upcoming CDC Vital Signs  report and web conference on the (often excessive) prescribing of antibiotics in US Hospitals. 


This morning we’ve the audio and transcript from that teleconference, excerpts and links to the MMWR early release, plus detailed reports from author and blogger Maryn McKenna and Lisa Schnirring at CIDRAP News.


First stop, the Teleconference contents, including links to the audio and transcript.


CDC Telebriefing: New Vital Signs Report - Are Prescribing Practices Putting Hospital Patients at Risk?

Poor antibiotic-prescribing practices in hospitals can needlessly put patients at risk for Clostridium difficile infection (deadly diarrhea) and future drug-resistant infections. This month, the CDC Vital Signs report looks at prescribing practices and variations, and calls on all U.S. hospitals to improve antibiotic-prescribing practices. More »

Transcript | AudioAudio/Video file


Accompanying this teleconference we have the following MMWR Early Release illustrating the wide disparity in prescribing practices across the nation.


Vital Signs: Improving Antibiotic Use Among Hospitalized Patients

Early Release

March 4, 2014 / 63(Early Release);1-7

Scott Fridkin, MD1, James Baggs, PhD1, Ryan Fagan, MD1, Shelley Magill, MD, PhD1, Lori A. Pollack, MD1, Paul Malpiedi, MPH1, Rachel Slayton, PhD1, Karim Khader, PhD2 Michael A. Rubin, MD, PhD2, Makoto Jones, MD1, Matthew H. Samore, MD2, Ghinwa Dumyati, MD3, Elizabeth Dodds-Ashley, PharmD3, James Meek, MPH4, Kimberly Yousey-Hindes, MPH4, John Jernigan, MD1, Nadine Shehab, PharmD1, Rosa Herrera1, L. Clifford McDonald, MD1, Amy Schneider, MPH1, Arjun Srinivasan, MD1 (Author affiliations at end of text)

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.


Our next stop is Maryn Mckenna’s Superbug Blog, where Maryn looks at both the issues of appropriate antibiotic stewardship, and a proposed budget increase for the HHS to monitor help control the growing problem of antibiotic resistance.


CDC: Some Hospitals Need Assistance Using Antibiotics Properly (And the New Federal Budget May Help)

Double-barreled news today from the US Centers for Disease Control and Prevention. In an analysis of several sets of hospital data, gathered by the agency and also purchased from independent databases, the CDC said it found that more than 37 percent of prescriptions written in hospitals involved some sort of error or poor practice, increasing the risk of serious infections or antibiotic resistance. And in a surprise announcement timed to the release of the federal draft budget, the agency said it is in line to receive $30 million to enhance its work combating antibiotic resistance in the US.

(Continue . . . )


Our last stop is CIDRAP News where Lisa Schnirring provides an excellent summation of yesterday’s reports.



CDC calls out antibiotic prescribing problems

Lisa Schnirring | Staff Writer | CIDRAP News

Mar 04, 2014

In a major report today that looked at antibiotic usage, the US Centers for Disease Control and Prevention (CDC) said some clinicians in similar hospital units prescribe triple the amounts, with some making the types of errors that fuel drug-resistance problems that put many more patients at risk.

On a more hopeful note, however, the same report also found hospitals that trim their antibiotic use by 30% can reduce Clostridium difficile (C diff) infections, a potentially deadly diarrheal infection known to sicken patients in health facilities, by 25%. The CDC published the findings today in Morbidity and Mortality Weekly Report (MMWR).

(Continue . . . )