Doctors and hospitals are putting patients at risk of deadly "superbug" infections because of frequent and sometimes careless use of antibiotics, according to a new report from the Centers for Disease Control and Prevention. Antibiotics are a staple of hospital care, and more than half of patients receive one before being discharged, the report found.
Yet doctors and others in some hospitals prescribe three times as many antibiotics as in other hospitals, even for patients with similar conditions, according to an analysis of more than 11,000 hospitalized patients.
Researchers found potential errors in one-third of cases involving urinary tract infections, as well as in the use of a powerful antibiotic called vancomycin. In some cases, doctors prescribed antibiotics without running a urine test or when patients didn't have symptoms. In other cases, doctors gave antibiotics for too long a period.
Previous studies have found the problem of improper prescribing to be even worse, with mistakes made in up to half of cases in which patients got antibiotics.
Although antibiotics can be life saving, using them too frequently promotes the growth of antibiotic-resistant bacteria, which are immune to the strongest medications. Patients are already suffering and dying from infections that are untreatable with any medication, said CDC director Thomas Frieden. The new report is an effort to "sound the alarm" about the problem.
"Poor prescribing practices put patients at risk," Thomas Frieden said. "The bottom line is that we have to protect patients by protecting antibiotics."
Misusing antibiotics also puts patients at serious risk of developing an antibiotic-resistant infection, Frieden said. In the study, hospitalized patients who received broad-acting antibiotics — those that kill a wide variety of bugs — were three times more likely to develop dangerous infections with bacteria called Clostridium difficile, orC. diff, which can cause severe diarrhea, blood infections and death.
About 250,000 hospitalized Americans a year develop C. diff infections, according to the CDC.
Dangerous C. diff bacteria can be picked up in hospitals. Although the bugs can often be kept in check by friendly gut bacteria, C. diff can multiply if beneficial gut bacteria are killed by antibiotics, which often wipe out the body's so-called "good bugs" along with the bad. The antibiotics that most often lead to C. diff infections include fluoroquinolones, cephalosporins, clindamycin and penicillins, according to the Mayo Clinic.
Researchers used mathematical models to estimate how changing prescribing patterns might affect these infections. They found that reducing the use of antibiotics that most often cause C. diff by 30% can reduce these infections in hospitalized patients by more than 26%. That could have wider effects outside the hospital, by reducing the number of the infections in the community, as well, researchers write.
Frieden said every hospital should have a program to use antibiotics more responsibly.
Hospitals that put such programs in place can save $200,000 to $900,000 a year, the study says. As part of the announcement Tuesday, the CDC issued guidelines for hospitals to improve their prescribing. "Improving antibiotic prescribing can save today's patients from deadly superbugs and protect lifesaving antibiotics for tomorrow's patients," Frieden said in a statement.
The United Kingdom already has sharply cut its rate of C. diff infections through a nationwide "antibiotic stewardship" initiative, said Arjun Srinivasan, a physician and CDC medical epidemiologist.
Although doctors and hospitals need to do better, the U.S. health care industry is working on the problem, said John Combes, senior vice president at the American Hospital Association.
"We recognize we must improve our practices, not only for the benefit of patients under our care but to preserve the effectiveness of antibiotics for future patients," Combes said.