Opportunities to Improve Antibiotic Prescribing in Hospitals

Newly published CDC data show opportunities to improve antibiotic prescribing in hospitals

A new paper from CDC estimates that more than half of antibiotics prescribed in hospitals for selected prescribing events were not consistent with recommended prescribing practices. This analysis is one of the largest to assess appropriateness of prescribing and sets a baseline for future analyses to measure the impact of antibiotic stewardship programs on hospital prescribing.

The analysis examined four common prescribing events in hospitalized patients for two conditions: community-associated pneumonia (CAP) and urinary tract infection (UTI); and two types of antibiotics: fluoroquinolones and intravenous (IV) vancomycin. Of the antibiotics prescribed for the four selected events in nearly 200 hospitals, prescribing was not supported for 55.9% of patients overall.
  • Among patients treated for CAP, antibiotic prescribing was not supported for 79.5% of patients.
  • Among patients treated for UTI present on admission to the hospital, antibiotic prescribing was not supported for 76.8% of patients.
  • Among patients prescribed fluoroquinolones, antibiotic prescribing was not supported for 46.5% of patients.
  • Among patients prescribed IV vancomycin, antibiotic prescribing was not supported for 27.3% of patients.
Prescribing was considered unsupported for many reasons, including long duration, antibiotic selection that did not follow guidelines, no documented infection signs or symptoms, or no lab results confirming the presence of an infection.
This analysis, published in JAMA Network Open, was conducted as a cross-sectional prevalence survey at 10 of CDC’s Emerging Infections Program sites with a random sample of inpatients on hospital survey dates from May–September 2015, including a total of 1,566 patients in 192 hospitals.

Regular assessments of the quality of antibiotic prescribing in hospitals can help estimate the appropriateness of antibiotic use across large groups of hospitals. Improving antibiotic use across all healthcare settings, including in hospitals, is key to slowing the spread of antibiotic-resistant pathogens and protecting patients.

Based on this analysis, Pew Charitable Trusts, in partnership with CDC and a panel of antibiotic use experts, is recommending the first-ever national targets to reduce inappropriate prescribing of certain antibiotics in U.S. hospitals. The panel focused its analysis on the four categories of prescribing described in this analysis – and account for the most common antibiotic therapies in U.S. hospitals.
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