Antimicrobial Prescribing Common in Inpatient Setting
Clinical question: What is the daily prevalence of antimicrobial use in acute-care hospitals?
Background: Inappropriate antimicrobial use is associated with adverse events and contributes to the emergence of resistant pathogens. Strategies need to be implemented to reduce inappropriate use. An understanding of antibiotic prevalence and epidemiology in hospitals will aid in the development of these strategies.
Study design: Cross-sectional prevalence study.
Setting: Acute-care hospitals in 10 states.
Synopsis: Surveys were conducted in 183 hospitals (11,282 patients) to assess the prevalence of antimicrobial prescription on a given day. The survey showed 51.9% of patients were receiving antimicrobials. Four antimicrobials (parenteral vancomycin, piperacillin-tazobactam, ceftriaxone, and levofloxacin) accounted for 45% of all antimicrobial treatments.
Additionally, 54% of antimicrobials were used to treat three infection syndromes: lower respiratory tract, urinary tract, and skin and soft tissue. This prescribing pattern was consistent between community-acquired infections and healthcare-acquired infections, as well as inside and outside the critical care unit. The study authors concluded that targeting these four antimicrobials and these three infection syndromes could be the focus of strategies for antimicrobial overuse.
Hospitalists need to use caution, as this data is from 2011 and patterns might have changed. Also, the study included only 183 hospitals, and generalizability is limited. In addition, the study did not take into account the patients’ diagnoses; therefore, it is difficult to assess the appropriateness of the antimicrobial prescriptions.
Bottom line: Use of broad spectrum antibiotics such as vancomycin is common in hospitalized patients.