Poor prescribing practices are putting patients at unnecessary risk for super-resistant infections, and errors in prescribing decisions also contribute to antibiotic resistance, making these drugs less likely to work in the future, says a report released last week by the U.S. Centers for Disease Control and Prevention.
Those strong words are based on the following specific findings by the CDC:
1. About 1 out of 3 times, prescriptions for the critical and common drug vancomycin, which is used to treat MRSA, included a potential error – given without proper testing or evaluation, or given for too long.
2. Antibiotic prescribing practices vary widely. For example, doctors in some hospitals prescribed up to 3 times as many antibiotics as doctors in similar areas of other hospitals. This difference suggests the need to improve prescribing practices.
3. Patients getting powerful antibiotics that treat a broad range of infections are up to 3 times more likely to get another infection from an even more resistant germ.
4. Although antibiotics save lives they can also put patients at risk for a Clostridium difficile infection, a deadly diarrhea that causes at least 250,000 infections and 14,000 deaths each year in hospitalized patients.
5. Decreasing the use of antibiotics that most often lead to C. difficile infection by 30% (this is 5% of overall antibiotic use) could lead to 26% fewer of these deadly diarrheal infections.
The second most common type of infection for which hospital clinicians wrote antibiotic prescriptions were for infections caused by drug-resistant Staphylococcus bacteria, such as MRSA (17% of the total).
The reason this matters is that the more you use antibiotics the less effective they become. This is the problem of antibiotic resistance and it means that future patients will pay with their lives for today’s overuse of antibiotics.
Dr. Brad Spellberg is an infectious disease specialist and leader in the field of developing ways to combat drug resistant infections. In an interview with Frontline last fall he gave us uncommon insight into the problem of resistance and how it’s beating us in our fight against infections:
Frontline: Was there a moment when you came to this realization about resistance? Tell me a little bit about your own personal discovery.
Dr. Spellberg: Antibiotic resistance is something that all infectious disease practitioners think about, know about and deal with. But the moment I guess where the power of the resistance was brought home to me was when I was a fellow in training and for the first time encountered a patient that was infected with bacteria that was not treatable, that was resistant to every antibiotic we had.
Do you remember that moment? What was it like?
This was a young woman who had leukemia, and she had gotten an infection, and you look at this computer screen, and what you see on the computer screen, or what I saw, was all the names of the different antibiotics we have, and then next to the names [was] “R” for “resistance” — R, R, R, R, R. And I kept looking down going, “Where is the ‘S’ for ‘susceptible’?” But there wasn’t any “S” for “susceptible.”
And so what do you say to that patient’s family member? There was nothing I could do. That was a very difficult conversation.
How did you feel then?
Sort of astonished that in the 21st century we could run out of drugs, that we had bacteria running around that had developed resistance to everything. We had nothing left.