'Last resort' antibiotic use increasing

Use of carbapenems, a powerful class of antibiotics often considered the last line of defense against severe multidrug resistant infections, increased 102% at Veteran's Affairs facilities between 2005 and 2009, according to data presented today at 2011 Society of Healthcare Epidemiology of America Annual Scientific Meeting.

“Use of these antibiotics helps the patient receiving the treatment, but has future consequences of innocent bystanders,” study researcher Makoto Jones, MD, of the University of Utah School of Medicine said in a press release. “The more these drugs are used the more resistance we see.

Jones and colleagues analyzed barcode medication administration data from 110 VA acute-care sites that had an average of at least 100 occupied patient days per month to determine trends in antibiotic use.

Although only a gradual increase was found in overall antibiotic use — 649 days of therapy per 1,000 patient days in 2005 vs. 775 days of therapy per 1,000 patient days in 2009 — the researchers noted dramatic increases in broad-spectrum antibiotic use.

In addition to the rise of carbapenems, IV vancomycin use increased 79% and the use of combination penicillin beta-lactamase inhibitors increased 41%.

Fluoroquinolones were the most commonly used antibiotic, the researchers found, accounting for 19.3% of total antibiotic use — however, use varied widely between hospitals ranging from 6.6% to 42.9%.

Furthermore, data indicated that 52% of all patients were administered at least one dose of an antibiotic during their stay in the hospital, regardless of presenting condition.

“In this era of multidrug resistant organisms, clinicians are placed in a difficult situation,” SHEA president Steve Gordon, MD said in a press release. “Clinicians must always put the patient first in treatment decisions, but we must empower effective antibiotic stewardship programs, infection prevention and control efforts.”

Although Gordon acknowledged that developing new antibiotics is important, he emphasized that ensuring effective and appropriate use of already available medications takes precedent.

“Dr. Jones' study is a clarion call for a need for better diagnostic tools to identify pathogens and resistance to implement effective antimicrobial stewardship,” Gordon said.

Reference

Jones M. #4932. Presented at: 2011 Society of Healthcare Epidemiology of America Annual Scientific Meeting; April 1-4, 2011; Dallas.

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