Controlling antibiotics and antibiotic resistance in hospitals
INDIANAPOLIS - In one of the first national studies on guidelines that control antibiotics and antibiotic resistance in hospitals, researchers from the Indiana University School of Medicine, the Regenstrief Institute, Inc. and the Richard Roudebush Veterans Administration Medical Center report that hospitals that follow national guidelines on controlling antibiotic use have lower rates of antibiotic resistance.
In a study published in the October issue of Infection Control and Hospital Epidemiology, the researchers studied four major types of antibiotic resistance at almost 450 hospitals, looking at what each hospital did to control antibiotic use and how this affected the rate of antibiotic resistance.
"We saw in this study, as in other work we have done, that antibiotic resistance is increasing rapidly. This increase is seen in all types of hospitals across the country - large and small, teaching and non-teaching, VA and non-VA," said Bradley N. Doebbeling, M.D., M.Sc., who led the study. He directs the IU Center for Health Services and Outcomes Research at the Regenstrief Institute and the IU School of Medicine. He also directs the VA Center for Implementing Evidence-Based Practice.
The study looked at measures to prevent development of antibiotic resistance as well as ways to stop its spread. The researchers reported that if hospitals implemented specific measures to control the use of antibiotics they were more likely to have succeeded in controlling antibiotic resistance.
Surprisingly, use of information technology didn't seem to have an impact. "We think that's because so few hospitals have the necessary technology available to support decisions related to prescribing antibiotics such as start and stop rules and how to use the best drug," said Dr. Doebbeling.
Prescription of antibiotics fall into three categories (1) preventive, often administered before or during surgery; (2) empiric - prescribed before the physician knows the specific nature of the bacteria; and (3) targeted - prescribed after bacterial culture results identify the bacteria actually causing the infection.
The study found that if a hospital had implemented measures to control the duration of administration of an empiric antibiotic, the institution had lower antibiotic resistance rates.
Having a restricted hospital formulary that limited the antibiotics available in the hospital was associated with a higher prevalence of antibiotic resistance, while simply limiting broad spectrum drugs helped prevent resistance.
"We think this may be because wrong decisions are made about which antibiotics are made available. Other studies have shown evidence that restricting formularies to previously effective antibiotics can actually help control antibiotic resistance," said Dr. Doebbeling.
"Antibiotic resistance is a growing problem for healthcare. Showing that recommended measures seem to prevent it in this nationally representative sample of hospitals is really encouraging," he said.
Co-authors of the study, which was funded by the Department of Veterans Affairs, are Alan J. Zillich, Pharm.D., Jason M. Sutherland, Ph.D., Stephen J. Wilson, M.D., Ph.D., Daniel J. Diekema, M.D., M.S., Ericka J. Ernst, Pharm.D., and Thomas E. Vaughn, Ph.D.
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