Antibiotic Use is Common in Hospitalized Patients

Even with Ebola and Enterovirus D68 on their plate, CDC still finds the time to do one of their day jobs - antimicrobial stewardship. In today's JAMA Infectious Diseases issue, Shelley Magill and her CDC EIP colleagues published (open access) a point-prevelance survey of antimicrobial use in acute care hospitals. The one-day survey included 11,282 randomly-selected patients from 183 hospitals in the 10 EIP states. In addition to recording which antibiotics the patient received, they also determined the rationale for use: treatment of infection (including empiric therapy), surgical prophylaxis, medical prophylaxis, a noninfection-related reason, or unknown.

Approximately 52% of patients received antibiotics that day or the day before. 58% of patients in ICUs vs 49% in other locations received antibiotics. Of those on antibiotics, half received one antibiotic, while the remaining 50% received two or more antibiotics. This seems like an obvious target for stewardship efforts. Encouragingly, 97% of the patients had a documented reason for receiving the antimicrobial: 76% for treatment of infection, 19% for surgical prophylaxis, and 7% for medical prophylaxis. The majority of patients treated had either a lower respiratory tract infection (34%), UTI (17%), skin/soft-tissue infection (15%) or GI infection (11%). I've included Table 3 below that highlights frequently used antibiotics for community vs health care facility-onset infections.

Overall a nice study and one that adds to the growing body of literature quantifying the rate of antimicrobials used clinically. The take home messages are a bit harder to identify. It would have been nice to follow these patients longer and capture their microbiology results to determine the proportion treated appropriately. It is also harder to make sweeping generalizations about antibiotic use in acute-care settings because the patients are very sick and could benefit from antibiotic treatment. If this were the outpatient setting, calls for improved use would be easier to make. Although, it does seems like we use too much vancomycin and pip-tazo in hospitals.


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