CDC: Antibiotic Overuse Can Be Lethal
Hospitals Have Cracked Down, But More Must Be Done
By Betsy McKay and Valerie Bauerlein
Wall Street Journal
Updated March 4, 2014 11:56 p.m. ET
The overuse of antibiotics in U.S. hospitals is putting patients at risk and helping to fuel the creation of deadly superbugs, according to a government report released Tuesday.
Prescribing practices vary widely, with doctors in some hospitals providing three times as many antibiotics for patients as physicians in other facilities treating similar types of patients, concluded the report, produced by the Centers for Disease Control and Prevention.
The CDC analyzed prescribing practices at 323 hospitals in 2010 and 11,282 patients at 183 hospitals in 2011. About 36% of patients studied were given the powerful antibiotic vancomycin without testing or for too long, the report found.
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Vital Statistics
A government report finds:
In 2010, 56% of patients discharged from 323 hospitals studied received antibiotics.Prescribing antibiotics could be improved in 37% of the most common scenarios.Antibiotics were most commonly prescribed for lung infections (22%), urinary-tract infections (14%) and suspected infections caused by drug-resistant Staphylococcus bacteria, such as MRSA (17%).Doctors in some hospitals prescribed up to 3 times as many antibiotics as doctors other hospitals.
—Source: Centers for Disease Control and Prevention
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Other antibiotics are similarly overused, it said, with nearly 40% of patients being treated for urinary-tract infections with these drugs, the report said.
Overprescribing antibiotics is making many of these drugs less effective because superbugs resistant to them are developing so fast. The practice also can sicken patients, by making them vulnerable to other types of infections such as Clostridium difficile, a bacterial infection.
Cutting back antibiotics use by 30% would reduce the number of infections with C. difficile by 26%, the report estimated. About 250,000 hospitalized patients a year develop C. difficile infections, which can lead to sepsis and death.
The findings suggest that while many hospitals recently have moved to crack down on antibiotic overuse, more should be done, the CDC said.
CDC Director Tom Frieden said he has treated patients who had run out of options of antibiotics capable of combating their infections, a frightening situation he doesn't want to see widespread.
"We have to protect patients by protecting antibiotics," he said. "The drugs we have today are endangered and any new drugs could be lost just as quickly."
Of particular concern is overuse of vancomycin because it is "the workhorse drug" used to treat MRSA, an increasingly common infection, and alternatives to it are expensive, said Arjun Srinivasan, the CDC's associate director for health care-associated infection prevention programs.
In more than 20% of cases studied in which intravenous vancomycin was given, the patient never had MRSA, he noted.
"A person comes into the hospital, they're very sick, they have lots of stuff going on, they're started on antibiotics and in a couple of days they're doing better, so why change anything," Dr. Srinivasan said, explaining the typical thinking in hospitals. "We're saying reassess. At 48 hours maybe what you thought was MRSA turned out to be something else. If it's not [MRSA], maybe it is time to stop the vancomycin."
The government set a goal of cutting the rate of C. difficile infection in half in five years, which the CDC said would save 20,000 lives, prevent 150,000 hospitalizations and trim $2 billion in health-care costs.
President Obama's budget proposal for fiscal 2015 includes $30 million for building an infrastructure to identify resistant bacteria strains and foster communication within communities about outbreaks and treatment, Dr. Frieden said.
The CDC initiative was welcomed by patient advocates, including Mary Brennan-Taylor, whose mother, Alice Brennan, died in 2009 in New York. She checked in to a community hospital with symptoms of gout in her leg and died six weeks later after being diagnosed with multiple hospital-acquired infections.
"We have heard the drumbeat for a number of years now about the overprescribing of painkillers, but make no mistake, the overprescribing of antibiotics is not benign," she said. "It can be lethal."
Most large academic hospitals have "antibiotic stewardship" programs in place in which physicians and pharmacists review prescribing practices and suggest changes where warranted to cut down on antibiotic use, said Sara Cosgrove, director of the antibiotic stewardship program at Johns Hopkins Hospital in Baltimore. But many community hospitals, where most people in the U.S. are treated, lack such programs, she noted.
"If we leave it at just the tertiary but not the community hospitals, it's not clear that we'll have any national impact," she said.
Write to Betsy McKay at betsy.mckay@wsj.com and Valerie Bauerlein at valerie.bauerlein@wsj.com
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