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CDC: Poor Antibiotic Stewardship Puts Patient Safety at Risk

The CDC found that 30 percent of antibiotic prescriptions are unnecessary, which poses serious challenges for patient safety, including antibiotic resistance.

- Healthcare providers could be jeopardizing patient safety and hospital quality by over-prescribing antibiotics. Despite warnings that inappropriate antibiotic use could lead to antibiotic resistance and superbugs, the Centers for Disease Control and Prevention (CDC) found that providers routinely over-prescribe antibiotics to patients who would not benefit from the treatment.

Over-prescribing of antibiotics poses serious threat to patient safety, hospital quality

According to recent study by the CDC, about one in every three of the 154 million antibiotic prescriptions written each year are considered unnecessary.

Researchers discovered that antibiotic prescriptions used to treat acute respiratory infections were the most avoidable. While 44 percent of outpatient antibiotic prescriptions were intended to treat these infections, many of these conditions are unresponsive to antibiotics, including the common cold, viral sore throats, bronchitis, and ear infections.

“Antibiotics are lifesaving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said Tom Frieden, MD, MPH, CDC Director. “Losing these antibiotics would undermine our ability to treat patients with deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.”

In a 2014 study, CDC researchers found that 78 percent of hospitals ordered redundant treatments that caused a rise in potential antibiotic resistance and dangerous superbugs. The unnecessary treatments generated higher healthcare costs, but did not improve patient outcomes.

The most recent study revealed that healthcare providers are still writing unnecessary prescriptions. An estimated 47 million avoidable prescriptions are written by physicians this year.

Along with antibiotic resistance, unnecessary prescribing could cause patients to experience avoidable allergic reactions and dangerous conditions, like Clostridium difficile, a type of life-threatening diarrhea.

To help physicians decrease inappropriate antibiotic use, the White House developed The National Action Plan for Combating Antibiotic-Resistant Bacteria in 2015. The program aims to decrease unnecessary antibiotic prescription rates by at least half by 2020.

“Setting a national target to reduce unnecessary antibiotic use in outpatient settings is a critical first step to improve antibiotic use and protect patients,” said Lauri Hicks, DO, Director of the CDC’s Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, and commander in the Public Health Service.

“We must continue to work together across the entire healthcare continuum to make sure that antibiotics are prescribed only when needed, and when an antibiotic is needed that the right antibiotic, dose, and duration are selected.”

The CDC received $160 million from Congress to implement the initiative in 2016. With the funding, the CDC expects to advance outbreak detection and prevention strategies, improve antibiotic use and resistance tracking tools, promote research, educate providers and patients about antibiotic resistance, and support community programs that improve antibiotic use.

The CDC also intends to help the healthcare industry reach the national target by offering guidance for healthcare stakeholders.

For outpatient healthcare providers, the CDC advised that physicians assess their prescribing habits and develop antibiotic stewardship programs that incorporate delayed prescribing into their routine.

Healthcare systems should provide more education on over-prescribing, communications, and clinical decision support, stated the CDC. Providers should also receive feedback on their performance in order to improve their prescribing routines.

The CDC recommended that patients ask when antibiotics are necessary and these conversations should include information on the risks of contracting an antibiotic-resistant infection.

In a previous statement, the CDC recommended that hospitals establish stewardship programs that develop policies and procedures for antibiotic use, provide physicians with regular feedback about prescription habits, and engage physicians through education.

As the CDC attempts to restructure how patients receive antibiotics, researchers have found how changes to the clinical workflow can improve inappropriate antibiotic use.

Researchers at the University of Southern California reported that primary care physicians can reduce unnecessary prescription use by allowing the electronic order set to suggest alternative treatments, requiring physicians to justify their antibiotic prescriptions in the EHR, and sending emails to providers about their prescribing rates in comparison with peers.

The largest reduction in antibiotic prescription rates was with the justification method, which was responsible for an 18 percent decrease.

Despite the benefits of improving clinical workflows, a CDC study from 2014 revealed that healthcare providers reverted to inappropriate prescribing habits once intervention programs ended. Prescription rates increased by 10 percent after education programs terminated.

As the healthcare industry pushes forward to value-based care, providers may need to implement or maintain intervention programs. Otherwise, patient safety rates may decline as superbugs emerge, which in turn will decrease the hospital’s quality rating.

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