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High Antibiotic Use in Hospitals May Boost Drug Resistance

Authors find over-use of broad-spectrum agents

About half of all U.S. hospital patients receive antibiotics, and these drugs are commonly the ones more likely to promote the growth of antibiotic-resistant bacteria, according to a new study published in JAMA.

Researchers at the Centers for Disease Control and Prevention (CDC) identified how many of more than 11,000 patients received antibiotics on a given day at 183 hospitals in the U.S. between May and September 2011. The patients were randomly selected from each hospital’s morning census on the survey date.

The investigators reviewed medical records retrospectively to gather data on antimicrobial drugs administered to patients on the survey date and on the day prior to the survey date, including reasons for administration, infection sites treated, and whether treated infections began in community or health care settings.

The authors found that, of 11,282 patients, 49.9% (5,635) were administered at least one antimicrobial drug; 77.5% of these drugs were used to treat infections, most commonly involving the lower respiratory tract, urinary tract, or skin and soft tissues, whereas 12.2% were administered for surgical and 5.9% for medical prophylaxis.

Of 7,641 drugs used to treat infections, the most common were parenteral vancomycin (14.4%), ceftriaxone (10.8%), piperacillin–tazobactam (10.3%), and levofloxacin (9.1%). These drugs were most commonly used for both community-onset and health care facility-onset infections and for infections in patients in critical care and noncritical care locations.

Most of the drugs administered to treat infections were given to patients outside critical care units (81.6%) and to patients with community-onset infections (69.0%).

More problematic, however, was that the most commonly used medications were broad-spectrum antibiotics. While narrow-spectrum antibiotics primarily target specific bugs — mostly the harmful ones — broad-spectrum antibiotics go after a broader range of bacteria, which can kill helpful bacteria as well.

Dr. Shelley Magill, of the CDC’s Division of Healthcare Quality Promotion, was particularly concerned to see that broad-spectrum drugs and drugs that treat resistant bacteria were often used for patients outside of intensive care units and for community-onset infections — not the most critically ill patients.

“Antimicrobial drugs are truly precious resources that have saved so many lives over the years. We need to use them judiciously if we are to preserve their effectiveness for future generations,” Magill remarked.

“Doctors lean on antibiotics because even if there’s a small chance they’ll work, that’s worth it when you have a sick patient,” said infectious disease epidemiologist Dr. Eli Perencevich. “Until we have better diagnostic tests, it will be harder to control antibiotic use in hospitals.”

Sources: MedicalXpress; October 8, 2014; and JAMA; October 8, 2014.

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