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No deadline was given for when these goals should be reached and some of the data to be used will depend on hospitals voluntarily releasing their numbers to the CDC.
The Centers for Disease Control and Prevention (CDC), along with the Pew Charitable Trusts, today unveiled a goal to decrease inappropriate prescribing of antibiotics for community-acquired pneumonia (CAP) and urinary tract infections (UTIs) by 90% and the overprescribing of the antibiotics fluoroquinolones and vancomycin by 95% in hospitals. But no deadline was given for when these goals should be reached and some of the data to be used will depend on hospitals voluntarily releasing their numbers to the CDC.
The recommendation was made by a panel of antibiotic prescribing experts chosen by Pew and based on CDC data published today in a study in JAMA Network Open.
“In this cross-sectional study of 1566 patients at 192 hospitals, antimicrobial use deviated from recommended practices for 55.9% of patients who received antimicrobials for community-acquired pneumonia or urinary tract infection present at admission or who received fluoroquinolone or intravenous vancomycin treatment,” the study states.
Antibiotic treatment was unsupported for 876 of 1566 patients. According to the study, that broke down to “110 of 403 (27.3%) who received vancomycin, 256 of 550 (46.5%) who received fluoroquinolones, 347 of 452 (76.8%) with a diagnosis of UTI, and 174 of 219 (79.5%) with a diagnosis of CAP. Among patients with unsupported treatment, common reasons included excessive duration (103 of 174 patients with CAP [59.2%]) and lack of documented infection signs or symptoms (174 of 347 patients with UTI [50.1%]).”
The data were collected from the medical records of patients included in hospital prevalence surveys that occurred from May 1 to September 30, 2015. They were analyzed between August 1, 2017 to May 31, 2020. But even though the data come before the coronavirus disease 2019 (COVID-19) pandemic, Pew and the CDC say that they have relevance to what’s been going on with COVID-19. According to Pew, 52% of patients who’ve been hospitalized for COVID-19 received at least 1 antibiotic, and many of those prescriptions were likely unnecessary.
The JAMA Network Open study states: “We observed that the percentages of unsupported use were higher for infection-based events than for antimicrobial-based events. This finding may have been associated in part with our inclusion of more specific criteria in the infection-based analysis pathways according to treatment guidelines from professional societies, which tend to focus on types of infections.”
Investigators note that some infectious disease and pharmacy professional societies have guidelines on when to use vancomycin “for serious infections caused by methicillin-resistant Staphylococcus aureus” but that “few national guidelines have focused on appropriate therapeutic uses of specific antimicrobials.”
According to a Pew statement, “Meeting these national reduction targets will require widespread adoption of effective antibiotic stewardship programs (ASPs), which promote responsible antibiotic prescribing, in order to minimize the harmful effects of inappropriate or unnecessary antibiotic use for patients and slow the spread of resistance.”
Hospitals are encouraged to report use of antibiotics to CDC’s National Healthcare Safety Network (NHSN) Antimicrobial Use Option. In addition, the CDC and Pew encourage public and private insurers to launch reimbursement programs to bolster ASPs, and health care systems, particularly the smaller ones, will need technical and financial assistance.