CDC Wants to Improve Antibiotic Overprescribing by Over 90%

The Centers for Disease Control and Prevention (CDC), along with the Pew Charitable Trusts, recently unveiled a goal to decrease inappropriate prescribing of antibiotics for community-acquired pneumonia (CAP) and urinary tract infections (UTIs) by 90% and the overprescribing of fluoroquinolone antibiotics and vancomycin by 95% in hospitals. The recommendation was made by a panel of antibiotic prescribing experts chosen by Pew and based on CDC data published March 18, 2021, in a study in JAMA Network Open.¹

“In this cross-sectional study of 1566 patients at 192 hospitals, antimicrobial use deviated from recommended practices for 55.9% of patients who received antimicrobials for [CAP] or [UTI] present at admission or who received fluoroquinolone or intravenous vancomycin treatment,” the study states.

Shortly after the study was published, Arjun Srinivasan, MD, the CDC’s associate director for health care association infection prevention programs, told Infection Control Today® that he envisions reaching the goal by 2025, adding that a lot of progress has already been made in the effort to cut back on inappropriate prescribing of antibiotics since 2015.² “The first phase of that so-called CARB [Combating Antibiotic-Resistant Bacteria] action plan was from 2015 to 2020,” Srinivasan told ICT®.³ “And the second phase is 2020 to 2025. In my opinion, I know it’s ambitious, but I think we should line up with that.”

Srinivasan also said that infection preventionists (IPs) should be a part of any effective antimicrobial program. “I think that the key is for the [IPs] to make sure that they’re connected with their stewardship programs,” Srinivasan told ICT®. “And I think in almost every instance where I interact with hospitals, that connection is already present, and it’s very strong.”

In the JAMA Network Open study, antibiotic treatment was unsupported for 876 of 1566 patients. That broke down to “110 of 403 (27.3%) who received vancomycin, 256 of 550 (46.5%) who received fluoroquinolones, 347 of 452 (76.8%) with a diagnosis of UTI, and 174 of 219 (79.5%) with a diagnosis of CAP. Among patients with unsupported treatment, common reasons included excessive duration (103 of 174 patients with CAP [59.2%]) and lack of documented infection signs or symptoms (174 of 347 patients with UTI [50.1%]).”

The data were collected from the medical records of patients included in hospital prevalence surveys that occurred from May 1, 2015, to September 30, 2015. They were analyzed between August 1, 2017, and May 31, 2020. But even though the data came before the COVID-19 pandemic, Pew and the CDC say that they have relevance to what’s been going on with COVID-19. According to Pew, 52% of patients who have been hospitalized for COVID-19 received at least 1 antibiotic, and many of those prescriptions were likely unnecessary.

In his interview with ICT®, Srinivasan said antibiotic overprescribing that the CDC tracked during the COVID-19 pandemic “represents the fact that you had a lot more patients presenting to the hospital with signs and symptoms consistent with pneumonia. They had cough, they had fever, they had chest x-ray infiltrates. And in some of those instances, it was likely difficult to distinguish who had a true respiratory tract bacterial infection and whose symptoms were only due to COVID-19. So not very surprising that we did see a rise in prescribing of those agents.”

Hospitals are encouraged to report use of antibiotics to CDC’s National Healthcare Safety Network Antimicrobial Use Option. In addition, the CDC and Pew encourage public and private insurers to launch reimbursement programs to bolster application service providers; and health care systems, particularly the smaller ones, will need technical and financial assistance.

References:

1. Magill SS, O’Leary E, Ray SM, et al; Emerging Infections Program Hospital Prevalence Survey Team. Assessment of the appropriateness of antimicrobial use in US hospitals. JAMA Netw Open. 2021;4(3):e212007. doi:10.1001/jamanetworkopen.2021.2007
2. Diamond F. Antibiotic stewardship programs need infection preventionists. Infection Control Today®. Published online March 23, 2021. Accessed March 29, 2021. https://www.infectioncontroltoday.com/view/antibiotic-stewardship-programs-need-infection-preventionists
3. National Action Plan for Combating Antibiotic-Resistant Bacteria. CDC. March 2015. Accessed March 23, 2021. https://www.cdc.gov/drugresistance/pdf/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf