• Scott Fridkin, James Baggs, Ryan Fagan, Shelley Magill, Lori A Pollack, Paul Malpiedi, Rachel Slayton, Karim Khader, Michael A Rubin, Makoto Jones, Matthew H Samore, Ghinwa Dumyati, Elizabeth Dodds-Ashley, James Meek, Kimberly Yousey-Hindes, John Jernigan, Nadine Shehab, Rosa Herrera, Clifford L McDonald, Amy Schneider, Arjun Srinivasan, and Centers for Disease Control and Prevention (CDC).
• MMWR Morb. Mortal. Wkly. Rep. 2014 Mar 7;63(9):194-200.

BackgroundAntibiotics are essential to effectively treat many hospitalized patients. However, when antibiotics are prescribed incorrectly, they offer little benefit to patients and potentially expose them to risks for complications, including Clostridium difficile infection (CDI) and antibiotic-resistant infections. Information is needed on the frequency of incorrect prescribing in hospitals and how improved prescribing will benefit patients.MethodsA national administrative database (MarketScan Hospital Drug Database) and CDC's Emerging Infections Program (EIP) data were analyzed to assess the potential for improvement of inpatient antibiotic prescribing. Variability in days of therapy for selected antibiotics reported to the National Healthcare Safety Network (NHSN) antimicrobial use option was computed. The impact of reducing inpatient antibiotic exposure on incidence of CDI was modeled using data from two U.S. hospitals.ResultsIn 2010, 55.7% of patients discharged from 323 hospitals received antibiotics during their hospitalization. EIP reviewed patients' records from 183 hospitals to describe inpatient antibiotic use; antibiotic prescribing potentially could be improved in 37.2% of the most common prescription scenarios reviewed. There were threefold differences in usage rates among 26 medical/surgical wards reporting to NHSN. Models estimate that the total direct and indirect effects from a 30% reduction in use of broad-spectrum antibiotics will result in a 26% reduction in CDI.ConclusionsAntibiotic prescribing for inpatients is common, and there is ample opportunity to improve use and patient safety by reducing incorrect antibiotic prescribing. Implications for Public Health: Hospital administrators and health-care providers can reduce potential harm and risk for antibiotic resistance by implementing formal programs to improve antibiotic prescribing in hospitals.

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