Local hospitals working to combat overuse of antibiotics

Local hospitals working to combat overuse of antibiotics

CHAMPAIGN — At a hospital in Urbana, Mark Pritchard said he doesn't know whether to be "scared or just worried."

Another warning about the overuse of antibiotics and rise of drug-resistant "superbugs" was issued last week, this one aimed at prescribing practices in hospitals. But Pritchard, a clinical pharmacist at Presence Covenant Medical Center, said antibiotic misuse and overuse is a broader community issue.

"We're part of the problem, but we're not all of the problem," he said.

The Centers for Disease Control and Prevention reported more than half of all patients in the hospital get an antibiotic, and doctors in some hospitals prescribe three times as many antibiotics than those in others — even though patients were receiving care in similar areas of the hospitals.

The CDC also found there were errors a third of the time in prescribing practices for the treatment of urinary-tract infections and the use of the common drug vancomycin. Either the drug was given without the right testing, or it was given for too long.

Antibiotics have been in use since the 1940s, but over time, many of the bacteria these powerful drugs treat have adapted, making the drugs less effective or, in some cases, ineffective.

Incorrect antibiotic prescribing practices put patients at risk for preventable allergic reactions, super-resistant infections and a potentially deadly diarrhea infection called Clostridium difficile, also called "C. diff" for short, according to the CDC.

C. diff infections are linked to 14,000 U.S. deaths a year. Most infections are connected with receiving medical care.

Officials at local hospitals say antibiotics use and C. diff infections have their attention.

"It's a big issue," said Dr. Robert Healy, Carle's chief medical quality officer. "We have these antibiotics that are very effective, but the bacteria evolve like every other living thing and it's a constant battle trying to fight them off."

C. diff bacteria can be picked up in health care settings and multiply in the guts of patients on powerful antibiotics, because the drugs wipe out the good bacteria along with the bad.

If hospitals reduced the use of the antibiotics that most often cause deadly diarrheal infections with C. diff by just 30 percent, the CDC urged, they could reduce these infections by more than 25 percent.

For 2012, the latest year for which data is available from the Illinois Department of Public Health, both Covenant Medical Center and its sister hospital, Presence United Samaritans Medical Center, had rates of C. diff infections considered to better than average or at the best possible rates, and Carle's infection rate was considered average.

To improve hospital antibiotic prescribing practices, the CDC is calling on hospitals to adopt a seven-step stewardship program that suggests such improvements as reassessing the choice, dose and duration of the antibiotic a patient is taking within 48 hours.

Healy said Carle is already following all seven steps of the CDC program, and Covenant and United Samaritans pharmacists said their hospitals have most components in place.

Antibiotics use is "a major concern for us," said Beth Ann Mason, a clinical pharmacist at Presence United Samaritans Medical Center in Danville. "Fortunately, our resistance rates follow the national trends. We're not seeing any major issues."

One way an antibiotics stewardship program can work:When a broad-spectrum antibiotic generally reserved to treat highly resistant bugs is ordered, an infectious disease doctor is consulted to get involved in the decision, Healy said.

"When those are ordered, there is a recommendation that pops up for the doctor for an infectious disease consult," he said.

Then, 24 to 48 hours later, doctors who have patients on these drugs are given a reminder about that.

Once this system was implemented, Healy said, there was a 10 percent reduction in the use of this type of antibiotics at Carle.

Carle recently looked at the emergency room use of a category of drugs called fluoroquinolones — broad-spectrum antibiotics associated with C. diff infection — to treat urinary tract infections.

"Using the best evidence out there, we were able to decrease fluoroquinolones by half," Healy said.

All three hospitals also issue period summaries, called antibiograms, that show the lab-tested sensitivity of bacterial strains to various antibiotics, and send this information to doctors to help them make prescribing decisions.

Involving an infectious-disease doctor in the use of broad-spectrum antibiotic use helps makes sure the drugs aren't being used inappropriately, Pritchard says. Covenant pharmacists also follow patients on certain antibiotics once they're started and then consult with doctors to see if they want to narrow the antibiotic spectrum, he said.

Doctors will sometimes start patients on broad-spectrum antibiotics before lab results are available to prevent deaths, but when culture results become available, sometimes a switch to a narrower antibiotic can be made, Pritchard said.

"We always want to narrow the spectrum when we can," he added.

Mason said United Samaritans looked at the time it was taking its lab to produce results that would allow for narrowing an antibiotic, and shortened it from three days to a day and a half.

Pritchard said doctors at Covenant have been good about following the hospital's antibiotics guidelines, and that is working hand-in-hand with good infection control measures.

The hospitals are working to do better, these spokesmen say, but everyone needs to be paying more attention to antibiotics overuse and consequences developing down the road.

"We're not getting the new antibiotics to treat the infections, and we're left with no new antibiotics to treat the infections," Mason said.

Pritchard said some folks tend to think of antibiotics as "some kind of magic bullet."

"You don't need to treat everything with an antibiotic, and it's best that you don't treat everything with an antibiotic," he said.

Doctor's orders

DON'T take antibiotics for viral infections, such as colds or the flu. They only cure bacterial infections.
DON'T pressure a doctor to prescribe an antibiotic.
DON'T save an antibiotic for future use or take one intended for someone else.

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