November 18, 2014
The Question
How and how often do hospitals change courses of empirical antibiotic therapy? Does this change when they have diagnostic information from cultures or imaging?
What we found
We studied patient charts from six US hospitals, and ultimately 730 were randomly selected that met inclusion criteria and were taking antimicrobials. Of these, though many patients were appropriately prescribed antibiotics, there were several categories of patients that were not. For instance, thirty percent of patients who received antibiotics from day one were afebrile and had normal white blood cell counts—in other words, they had no obvious signs of infection. Sixty percent of patients had cultures taken (which is useful to determine if antibiotics are necessary), but of those who tested negative and could have deescalated antibiotics, only 22 percent did. Fewer than one in three patients ultimately had their course of antibiotics narrowed during their hospital stay.
Why it matters
Antibiotic-resistant bacteria infect 2 million Americans annually, and use of antibiotics in situations where they aren’t required is a major driver of resistance. A significant percentage (frequently a majority) of patients admitted to US hospitals receive antibiotics during their stay, and antibiotic stewardship programs are a potentially helpful tool for limiting resistance. Appropriate deescalation of antimicrobials is a critical component of these programs, and this study set out to see whether deescalation was effectively occurring in six major US hospitals. What we found—that deescalation isn’t ocurring as often as it could—is critical to know for creating and maintaining effective stewardship programs in the future.
