Steering the Antibiotic Enterprise

Today there have been multiple media stories regarding the misuse of antibiotics in hospitalized patients and the risk that this practice poses. Not only does it waste money, it sets up a scenario in which infections such as Clostridium difficult thrive. 

C.diff, as it is colloquially known, is a bacterium that can cause a range of symptoms from diarrhea to life-threatening intestinal perforation. It also adds significant days onto a hospital stay, can spread to other patients, and is expensive. 

The media attention is focused on a report from the CDC which studied the use of antibiotics in hospitals. What the CDC found is alarming:

  • Over 50% of hospitalized patients receive an antibiotic of some sort
  • Scrutinizing the use of vancomycin and the treatment of urinary tract infection revealed that treatment could have been improved in close to 40% of cases 
  • Antibiotics prescribed for urinary tract infections were particularly egregious with many being prescribed without a definitive diagnosis (i.e. no symptoms, no culture ordered)
  • Using mathematical tools, it was found that a 30% decrease in antibiotic use would decrease C.diff rates by a similar amount

The bottom line of this report is that antibiotic stewardship--something that is part of the daily routine of every infectious disease physician--is a key component of controlling the rates of C.diff, improving cost-effectiveness, and improving patient care.