Health officials have long been warning us about the overuse of antibiotics and the rise of drug-resistant "superbugs." Now the Centers for Disease Control and Prevention is shining a light on how hospitals are contributing to the problem.
"Prescribing (antibiotics) varies widely among hospitals," CDC Director Dr. Thomas Frieden, an infectious disease expert, said in a press conference Tuesday. "Practices that are not optimal are putting patients at unnecessary risk of future drug-resistant infections, allergic reactions and intestinal infections that can be deadly."
About half of hospitalized patients receive antibiotics during their stay. But there is a significant difference in the rate of antibiotic prescription, with some hospitals prescribing up to three times as many antibiotics as others, according to a new report published Tuesday in the CDC publication Vital Signs.
Clostridium difficile - also known as “C. diff" - is a bacteria that causes diarrhea, and mostly causes infections in patients taking antibiotics. "Reducing the use of high-risk antibiotics by 30% can lower deadly diarrhea infections by 26%," the report noted.
Frieden said the overuse and misuse of antibiotics is contributing to an increase in drug-resistant bacteria, which render antibiotics useless. He remembers treating patients who had "run out" of antibiotics they could take.
"We have to protect patients by protecting antibiotics," he said.
In an effort to protect antibiotics, the CDC released suggestions for hospitals and state and local health departments to improve prescribing practices.
Specifically, the CDC's plan is made up of two broad strategies. Hospitals are being asked to implement a seven-step checklist that includes tracking current prescription practices, reporting patterns of drug-resistant bacteria and educating staff about more effective use of antibiotics.
State and local health departments are being asked to work with hospitals to track rates of drug-resistant bacteria and implement forms that would transfer with patients between facilities, listing information about drug-resistant bacteria the patients may be carrying.
The CDC also suggests physicians order tests before beginning to treat a patient, then start treatment promptly, keeping careful notes about the course of treatment and checking on the patient's status two days later to ensure the antibiotics are working properly.
For doctors, there's a tension between thinking of the greater good of society and the immediate needs of the patient, says Dr. Scott Flanders, a professor of medicine at the University of Michigan, who was not involved with the report.
Often, patients come in to hospitals with symptoms that could be indicative of a bacterial infection, and doctors will begin antibiotics immediately, Flanders said, erring on the side of treatment.
In conjunction with the CDC's suggestions for hospitals and health departments, the federal government is expanding the National Healthcare Safety Network, which helps track infections.
The CDC's report was released in collaboration with the American Hospital Administration. Dr. John Combes, senior vice president of the AHA, said decreasing the rate of infections caught in hospitals is an important part of decreasing antibiotic prescription rates in hospitals overall.
The AHA will release a list of resources for hospitals to help improve antibiotic-prescription practices in the next year. Reducing rates of antibiotic-resistant bacteria and C. difficile will take some work, Combes said.
"Preventing infections is a never-ending process within the organization, and new challenges and situations are emerging daily," said Combes. "But we recognize that more can be done and will be done."