In the Journals

Broad-spectrum antimicrobial use common across US hospitals

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October 17, 2014

The use of broad-spectrum antimicrobial drugs, including piperacillin-tazobactam and vancomycin, was common in US acute care hospitals, even when treating community-onset infections and patients outside of critical care units, according to CDC researchers.

“To minimize patient harm and preserve effectiveness, it is imperative to critically examine and improve the ways in which antimicrobial drugs are used,” the researchers wrote in JAMA. “Improving antimicrobial use in hospitals benefits individual patients and also contributes to reducing antimicrobial resistance nationally.”

Shelley S. Magill, MD, PhD, of the CDC’s Division of Healthcare Quality Promotion, and colleagues conducted 1-day prevalence surveys at 183 hospitals between May and September 2011. They selected a random sample of inpatients from each hospital’s morning census on the survey date and reviewed records to identify patients receiving antimicrobial drugs, the drugs administered and the reason for the drug.

Among the 11,282 patients identified, 5,635 were given at least one antimicrobial drug. Although most of the patients (82.5%) were outside of the critical care unit, the prevalence of antimicrobial use was highest in critical care units (57.7%) compared with other locations. The majority of antimicrobial drugs (77.5%) were prescribed to treat infections. Another 19% were prescribed for surgical prophylaxis and 6.9% were prescribed for medical prophylaxis. The remainder were for noninfection-related reasons (0.71%) or had no documented rationale (6.9%).

The most common drugs used to treat infections were parenteral vancomycin (14.4%), ceftriaxone (10.8%), piperacillin-tazobactam (10.3%) and levofloxacin (9.1%). Drugs given for infections were mostly for community-onset infections (69%) and mainly given to patients outside of critical care units (81.6%). The most common infections were lower respiratory tract infections (34.1%), urinary tract infections (17%), skin and soft tissue infections (15.4%) and gastrointestinal infections (10.8%).

“Results from this prevalence survey provide patient-level information that augments data on antimicrobial drug consumption and points to specific areas where interventions to improve antimicrobial use may be needed, such as vancomycin prescribing and respiratory infection treatment, supporting the CDC’s recommendation that every acute care hospital implement an antimicrobial stewardship program.”

Disclosure: One researcher has financial relationships with the Infectious Disease Consulting Corporation and another receives travel support from Parexel.

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