'Superbugs' kill more than 35K people in the US each year. Doctors may be partially to blame, study suggests.
As the medical community finds treatments to combat the coronavirus, another deadly enemy continues to lurk in hospitals across the country: antibiotic-resistant infections.
The Centers for Disease Control and Prevention calls antibiotic resistance one of the “biggest public health challenges of our time,” and a new study suggests doctors may be partially to blame for its prevalence.
The study, published last week in the peer-reviewed journal JAMA Network Open, found more than half of antibiotics prescribed in hospitals were not consistent with recommendations, alarming health experts who say inappropriately prescribing medications contributes to antibiotic resistance.
"We’re in an antibiotic crisis. Many call this the 'silent pandemic' going on concurrently with the coronavirus pandemic," said Dr. Debra Goff, infectious clinical pharmacist and professor of pharmacy who leads antibiotic resistance efforts at The Ohio State University Wexner Medical Center.
In the agency's study, researchers looked at 1,566 patients who received antibiotics and found that 55.9% shouldn’t have received them based on practice guidelines.
Guidelines didn’t support prescribing antibiotics to 79.5% of patients who were treated for community-acquired pneumonia and 76.8% of patients who were treated for a urinary tract infection.
Prescriptions were flagged if there were no documented signs or symptoms of infection, no lab results or if antibiotics were prescribed longer than necessary.
Out of the patients that may have been unnecessarily prescribed antibiotics, more than 50% lacked documented infections signs or symptoms and nearly 60% were given medications for an excessive duration.
Patients are often given antibiotics when they’re hospitalized and then prescribed a new course of antibiotics when they’re discharged, Goff says, leading them to take medications for up to two weeks.
“These football scores of antibiotic duration – 7, 10, 14 days – were not developed based on clinical outcome studies. Those durations were just how the researchers designed the study,” she said. “(But) there’s data clearly showing that these traditional durations are no longer necessary … shorter is better.”
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Taking antibiotics longer than necessary increases a patient's chance of developing antibiotic resistance, said Dr. Ryan Shields, an infectious disease pharmacist and associate director of the University of Pittsburgh Medical Center’s antibiotic stewardship program.
This occurs when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them, according to the CDC.
Studies have shown patients with antibiotic-resistant infections are at an increased risk of worse clinical outcomes, such as severe disease and death, compared to patients with infections that can be treated with antibiotics.
This may be due to significantly longer hospital stays, high risk of treatment failure and increased risk of undergoing surgery, Goff said. According to the CDC, more than 35,000 people die from antibiotic-resistant infections in the U.S. each year.
They’re not only deadly, but costly. According to a January report by the CDC and the University of Utah, six multi-drug resistant pathogens are estimated to cost the U.S. more than $4.6 billion annually.
“Every day they’re in the hospital consuming resources," Goff said. "Add it all up … antibiotic resistance costs a lot of money.”
Additionally, antibiotics that specifically address antibiotic-resistant pathogens are more expensive than traditional antibiotics, running at a price of about $400 to $1,000 a day compared to about $25.
The CDC study was conducted between 2011 through 2015, which means prescribing practices have likely changed since the report, said Shields of UMPC. In 2017, the Joint Commission put into effect a new accreditation standard for antimicrobial stewardship programs in hospitals to educate staff and practitioners about antibiotic resistance.
However, it’s not just doctors who carry the responsibility of combating antibiotic-resistant infections, health experts say. Oftentimes, the main reason patients visit their doctors is to get an antibiotic prescription.
“When you’re paying for a doctor’s visit, many are going to the doctor for the antibiotic. They pressure the doctor,” Goff said. “That’s where the consumer and patients also need education.”