Vital Signs: Making Health Care Safer

Poor antibiotic prescribing harms patients

Antibiotic prescribing practices vary widely and errors are common.

• About half of patients receive an antibiotic for at least one day during the course of an average hospital stay.
• The most common types of infections for which hospital clinicians wrote antibiotic prescriptions were lung infections (22%), urinary tract infections (14%), and suspected infections caused by drug-resistant Staphylococcus bacteria, such as MRSA (17%).
• About 1 out of 3 times, prescribing practices to treat urinary tract infections and prescriptions for the critical and common drug vancomycin included a potential error – given without proper testing or evaluation, or given for too long.
• Doctors in some hospitals prescribed up to 3 times as many antibiotics as doctors in similar areas of other hospitals. This difference suggests the need to improve prescribing practices.

Poor prescribing puts patients at risk.

• Although antibiotics save lives (for example, in the prompt treatment of sepsis, a life-threatening infection throughout the body), they can also put patients at risk for a Clostridium difficile infection, deadly diarrhea that causes at least 250,000 infections and 14,000 deaths each year in hospitalized patients.
• Decreasing the use of antibiotics that most often lead to C. difficile infection by 30% (this is 5% of overall antibiotic use) could lead to 26% fewer of these deadly diarrheal infections. These antibiotics include fluoroquinolones, β-lactams with β−lactamase inhibitors, and extended-spectrum cephalosporins.
• Patients getting powerful antibiotics that treat a broad range of infections are up to 3 times more likely to get another infection from an even more resistant germ.

SOURCE: CDC Vital Signs, 2014

View large graphic and text.

SOURCE: CDC Vital Signs, 2014

View large graphic and text.

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Federal government is

• Expanding the National Healthcare Safety Network to help hospitals track antibiotic use and resistance.
• Sharing prescribing improvement recommendations and tools with clinicians and administrators. www.cdc.gov/getsmart/healthcare
• Supporting networks testing new prescribing improvement strategies.
• Helping hospitals and health departments create regional programs to improve antibiotic prescribing.
• Improving health care for veterans by launching antibiotic stewardship programs in Veteran’s Health Administration hospitals.
• Providing incentives for development of new antibiotics.

State and local health departments can

• Gain an understanding of antibiotic stewardship activities in the state or area.
• Facilitate efforts to improve antibiotic prescribing and prevent antibiotic resistance.
• Provide educational tools to facilities to help prescribers improve practices.

Hospital CEOs/medical officers can

• Adopt an antibiotic stewardship program that includes, at a minimum, this checklist [PDF – 425 KB]:
  • Leadership commitment: Dedicate necessary human, financial, and IT resources.
  • Accountability: Appoint a single leader responsible for program outcomes. Physicians have proven successful in this role.
  • Drug expertise: Appoint a single pharmacist leader to support improved prescribing.
  • Act: Take at least one prescribing improvement action, such as requiring reassessment within 48 hours, to check drug choice, dose, and duration.
  • Track: Monitor prescribing and antibiotic resistance patterns.
  • Report: Regularly report to staff prescribing and resistance patterns, and steps to improve.
  • Educate: Offer education about antibiotic resistance and improving prescribing practices.
• Work with other health care facilities to prevent infections, transmission, and resistance.

Doctors and other hospital staff can

• Prescribe antibiotics correctly – get cultures, start the right drug promptly at the right dose for the right duration. Reassess the prescription within 48 hours based on tests and patient exam.
• Document the dose, duration and indication for every antibiotic prescription.
• Stay aware of antibiotic resistance patterns in your facility.
• Participate in and lead efforts within your hospital to improve prescribing practices.
• Follow hand hygiene and other infection control measures with every patient.

Hospital patients can

• Ask if tests will be done to make sure the right antibiotic is prescribed.
• Be sure everyone cleans their hands before touching you. If you have a catheter, ask each day if it is necessary.

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• MMWR
• Science Clips

• Vital Signs Issue details: Improving Antibiotic Use Among Hospitalized Patients, Morbidity and Mortality Weekly Report (MMWR)
• Vital Signs Press Release
• Checklist for Core Elements of Hospital Antibiotic Stewardship Programs
• Core Elements of Hospital Antibiotic Stewardship Programs
• Get Smart for Healthcare site
• HAI Prevention Stories from the States – South Dakota Improves Antibiotic Prescribing Practices [PDF – 377 KB]
• HAI Prevention Stories from the States – Improving Inpatient Antibiotic Prescribing Practices Across Georgia [PDF – 421 KB]
• Antibiotic RX in Hospitals: Proceed with Caution [PODCAST – 1:15 minutes]
• Antibiotic RX in Hospitals: Proceed with Caution [PSA – 0:60 seconds]
• CDC Healthcare-associated Infection Website
• Public Health Grand Rounds – Combating Resistance: Getting Smart About Antibiotics

On Other Web Sites

• Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship
• CDC Foundation – Your Employees at Risk: Why Safe Healthcare is Everyone’s Business
• Dr. Frieden Medscape Commentary – Antibiotic Prescribing in Hospitals: Improvements Needed
• MedlinePlus – Antibiotics
• The Doctor’s Channel – Tom Frieden with Steps Doctors and
  Hospitals Should Take
• The Health Care Blog – Tom Frieden on Safer Patient Care
• MedPage Today – Tom Frieden Discusses Antibiotic Resistance in Hospitals

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