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CDC Study: Hospitals Still Use Too Many Antibiotics

Carbapenem prescribing up 37%

U.S. hospitals continue to use powerful antibiotics to fight infections when less-effective antibiotics fail––a “worrisome” development as bacteria grow increasingly immune to treatment, according to a new study from the Centers for Disease Control and Prevention (CDC). The findings were published in JAMA Internal Medicine.

The authors said that their study, which examined prescribing patterns between 2006 and 2012, appears to be the first to provide national estimates of temporal trends in antibiotic use among U.S. hospitals.

The investigators used adult and pediatric drug-use data from the Truven Health MarketScan Hospital Drug Database, which includes approximately 300 hospitals and more than 34 million patients, to estimate patterns of inpatient antibiotic use and extrapolate these findings to all U.S. hospitals. The authors found that, overall, 55% of patients discharged received at least one dose of an antibiotic during their hospital visit.

Estimates of use decreased for aminoglycosides, first- and second-generation cephalosporins, fluoroquinolones, sulfa, metronidazole (all P < 0.001) and penicillins (P = 0.01), with the greatest decrease among fluoroquinolones. However, macrolides, third- and fourth-generation cephalosporins, glycopeptides, beta-lactam/beta-lactamase inhibitor combinations, carbapenems, tetracyclines, and other types of antibacterials all showed significantly increased use (P < 0.001 for all except third- and fourth-generation cephalosporins [P = 0.001]).

Specifically, the use of carbapenem increased by 37%. Carbapenem is considered an antibiotic of last resort against multiple bacteria that cause bloodstream infections, urinary tract infections, and pneumonia. Further, vancomycin use increased by 32%; the use of beta-lactam/beta-lactamase inhibitor combination antibiotics increased by 26%; and the use of third- and fourth-generation cephalosporins increased by 12%.

Antibiotic use did not vary significantly by facility bed size (P = 0.17) or urban or rural location (P = 0.34).

In June, the U.S. Department of Health and Human Services proposed a rule that would require hospitals that are paid by Medicare to track antibiotic use and to reduce antibiotic-resistant infections.

Sources: JAMA Internal Medicine; September 19, 2016; and Wall Street Journal; September 19, 2016.

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