Why are antimicrobial stewardship programs necessary? A few statistics illustrate the problem facing U.S. hospitals and their patients.
Up to 50% of all hospital patients receive unnecessary or inappropriate antimicrobial therapy, despite studies demonstrating antibiotic overuse for decades.1
A one-day point prevalence survey published in JAMA in 2014 showed that 50% of hospital patients were on at least one antimicrobial.2
Almost four out of five hospitals (78%) prescribe redundant antimicrobial therapy, even though professional societies have issued recommendations to the contrary since 2008. Most commonly, the redundancies involved antianaerobic regimens, particularly use of intravenous metronidazole and piperacillin-tazobactam, although use of dual beta-lactams is also high.1 Such duplicative therapy may cost U.S. hospitals $163 million each year, while increasing the risk to patients of adverse drug events and contributing to the development of multidrug resistant organisms.3
Multidrug resistant strains of pathogens can quickly achieve dominance. Researchers in the U.S. first isolated methicillin-resistant Staphylococcus aureus in 1968. By 1991, resistant strains accounted for 29% of all S. aureus isolates in U.S. hospitals, and by 2003, they comprised 42% of all S. aureus infections in hospitals and 60% in intensive care units.4,5
Prevalence of vancomycin-resistant enterococci rose from less than 1% of isolates from hospitalized patients in 1990 to 15% in 1997 to 28.5% in 2003. Today, nearly 80% of one common healthcare-associated Enterococcus species (E. faecium) resists vancomycin. A third of all hospital patients with Enterococcal infections have resistant strains, which lead to the deaths of 1,300 people each year. 4,6
Carbapenem-resistant Enterobacteriaceae (CRE), which are resistant to all or nearly all available antibiotics, have been found in every state except Idaho and Maine. The CDC estimates that the prevalence of carbapenem-resistant Klebsiella pneeumoniae rose 700% between 2003 and 2013.7
According to the Centers for Disease Control and Prevention (CDC), drug-resistant bacteria cause at least 2 million illnesses and 23,000 deaths in the U.S. each year.6
In addition, antibiotic use contributes to development of Clostridium difficile. C. difficile infects nearly 250,000 people each year, generally following medical care and antibiotic use. In the seven years following the emergence of a fluoroquinolone-resistant strain in 2000, deaths attributed to C. diff increased 400% and now exceed 14,000 patients per year. The CDC categorizes C. difficile as an “immediate public health threat that requires urgent and aggressive action.” 6
What has your hospital done to improve antimicrobial stewardship?
1. Schultz L, Lowe TJ, Srinivasan A, Neilson D, Pugliese G. Economic impact of redundant antimicrobial therapy in US hospitals. Infect Control Hosp Epidemiol. 2014 Oct;35(10):1229-35.
2. Magill SS, Edwards JR, Beldavs ZG, Dumyati G, Janelle SJ, Kainer MA, Lynfield R, Nadle J, Neuhauser MM, Ray SM, Richards K, Rodriguez R, Thompson DL, Fridkin SK; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA. 2014 Oct 8;312(14):1438-46.
3. Society for Healthcare Epidemiology of America. Unnecessary Antibiotic Use in Hospitals Responsible for $163 Million in Potentially Avoidable Healthcare Costs. http://www.shea-online.org/View/ArticleId/307/Unnecessary-Antibiotic-Use-in-Hospitals-Responsible-for-163-Million-in-Potentially-Avoidable-Healthc.aspx Accessed August 20, 2015.
4. CDC. Healthcare Infection Control Practices Advisory Committee (HICPAC). III. Epidemiology of MDROs. http://www.cdc.gov/hicpac/mdro/mdro_3.html Accessed August 20, 2015.
5. David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev. 2010 Jul;23(3):616-87.
6. CDC. Antibiotic Resistance Threats in the United States, 2013.
7. Patients Face More Lethal Infections from CRE. CDC Features. Last updated: February 20, 2015. http://www.cdc.gov/features/vitalsigns/hai/cre/ Accessed August 13, 2015.