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Poor Antibiotic Prescribing Putting Hospital Patients at Risk for Deadly Infections

(SALT LAKE CITY)—Poor prescribing practices for antibiotics are putting thousands of hospital patients at risk for potentially deadly infections and allergic reactions, according to a new report from researchers at the Centers for Disease Control and Prevention (CDC), the University of Utah and Salt Lake City Veterans Affairs Health Care System and other institutions.

The report, published by the CDC last week, found that physicians in some hospitals prescribe three times as many antibiotics as physicians treating patients in similar areas of other hospitals. Prescriptions to treat urinary tract infections (UTI) with vancomycin present problems, too, being given without proper testing or evaluation or for too long in about one-third of cases.

The study also examined potentially deadly diarrheal infections caused by the Clostridium difficile (C. diff) bacterium, which can be triggered by antibiotics. The research team in Utah used mathematical modeling to simulate C. diff infection in different hospital situations involving antibiotic prescriptions. C. diff can be transmitted from one person to another, so that had to be taken into account. A key result of their analysis was the prediction that C. diff infections could be reduced by up to 26 percent if 30 percent fewer high-risk antibiotics were prescribed.

The Utah team comprised four U of U faculty members, Karim Khader, Ph.D., U of U assistant professor of medicine, , M.D., M.S., assistant professor of medicine, Makoto M. Jones, M.D., M.S., assistant professor of medicine, Michael A. Rubin, M.D., Ph.D., M.S., associate professor of medicine, and Matthew H. Samore, M.D., professor of medicine and chief of epidemiology. The Utah research team is at the Salt Lake Informatics Decision Enhancement and Surveillance (IDEAS) Center at the Salt Lake City Veterans Affairs Health System.

As so-called "superbugs" become more resistant to even the strongest antibiotics, along with the potential for those drugs to cause infections, Samore believes that properly managing antibiotics prescriptions is an important public health issue.

"Every time someone in a hospital is treated with antibiotics, everybody else in the hospital is affected," he says. "There is a major effort right now to reduce inappropriate antibiotic use, and this study really sharpens that message."

Improving the way antibiotics are prescribed can save patients from deadly superbugs while protecting live-saving antibiotics for future patients, according to CDC Director Tom Frieden, M.D., M.P.H. "Health care facilities are an important part of the solution to drug resistance and every hospital in the country should have a strong antibiotic stewardship program."

The study showed that more than 50 percent of hospitalized patients receive an antibiotic at some point during their stay. The most common types of infections for which antibiotics are prescribed are UTIs and lung infections as well as infections caused by drug-resistant Staphylococcus bacteria, such as MRSA.

The researchers looked at the records of hundreds of hospitals across the country for the study.