Study suggests redundant antibiotic use is widespread in US hospitals
An analysis of 4 years of records from 505 US hospitals suggests that duplicative use of antibiotics is pervasive, leading to needless costs and potentially increasing resistance to the drugs, says a report yesterday in Infection Control and Hospital Epidemiology (ICHE).
The report, by a team from the Premier Safety Institute, Premier Healthcare Alliance, and the Centers for Disease Control and Prevention, says that some clinicians use antibiotics with overlapping sets of target pathogens to reduce the chance that the infecting pathogen will resist the regimen. The authors assert that aside from this use, there are very few clinical indications for using antimicrobials with overlapping functions.
The researchers analyzed data on patients discharged from Jan 1, 2008, through Dec 31, 2012. Potentially redundant antimicrobial therapy was identified from pharmacy records and was defined as treating a patient with overlapping antibiotics for 2 or more consecutive days.
They found evidence of potentially inappropriate, redundant antimicrobial coverage in 394 of the 505 (78%) hospitals, representing 32,507 cases and involving 23 different drug combinations. Three drug regimens for anaerobic bacteria accounted for 70% of the cases, with the combination of metronidazole and piperacillin-tazobactam alone accounting for 53% of cases.
The team counted 148,589 days of redundant therapy, representing more than $12 million in potentially avoidable costs over the 4 years. If the same level of redundant treatment occurred nationwide, the amount would be $163 million, according to a press release from the Society for Healthcare Epidemiology of America (SHEA), publisher of ICHE.
In addition to fostering antimicrobial resistance and excess costs, unnecessary intravenous combinations can increase the risk of adverse drug events, the SHEA release said.
"Sometimes in an effort to 'do whatever it takes' to fight a serious infection, clinicians use multiple antibiotics to treat the same infection," said lead author Leslie Schultz, RN, PhD, in the SHEA release. "This practice can contribute to antimicrobial resistance, put patient safety at risk and increase costs. We hope these findings help to enhance the antimicrobial stewardship initiatives that the majority of U.S. hospitals already have in place today."
Sep 9 ICHE report
Sep 10 SHEA press release
Flu activity still high in some Southern Hemisphere countries
The Southern Hemisphere's flu season is still under way in many countries, notably in Australia, where some flu markers are at a 5-year high, the World Health Organization (WHO) said in a Sep 8 global flu update.
Flu activity in Australia has increased sharply over the past few weeks, with the 2009 H1N1 virus dominating in most areas, though H3N2 was the most common virus detected in New South Wales and the Australian Capital Territory. New Zealand reported that flu activity is running slightly above expected threshold levels.
Elsewhere, South Africa reported high flu activity, with H3N2 as the dominant strain. In temperate South American countries, flu activity has started to decline, though Paraguay reported that doctor's visits for flu is still at high alert-zone levels.
In tropical areas of the Americas and the Caribbean, flu activity was mainly low, with influenza B circulating in some areas, co-circulating with 2009 H1N1 in Guatemala and Panama and co-circulating with H3N2 in the Dominican Republic, Honduras, and Jamaica.
Flu activity remained low in most parts of Africa and eastern Asia, though some flu activity continued in southern China, caused mainly by H3N2 and influenza B. India reported an increase in flu activity, also from H3N2 and influenza B.
In Northern Hemisphere countries, flu remained at interseasonal levels, the WHO said.
Globally, during the middle weeks of August, influenza A viruses accounted for almost 82% of the flu detections, and, of the subtyped ones, 82% were the H3N2 strain, the WHO said.
Sep 8 WHO global flu update
Chan: WHO must address inequalities as it combats disease
World Health Organization (WHO) Director-General Margaret Chan, MD, MPH, said the agency will continue to battle infectious diseases in multiple ways in the coming years, with an emphasis on promoting universal health coverage and using other approaches to combat social inequality, according to an editorial today in a special issue of Science Translational Medicine focusing on global health.
The issue also contains reviews on new technologies to fight emerging viral diseases and on the importance and promise of new vaccine developments.
Chan said that, as the WHO looks to next year, when the United Nations Millennium Development Goals expire, it will continue to battle infectious disease while it also turns to combating poverty and non-communicable diseases like heart disease and cancer. "Our attention . . . is focused on ways to build on the global health successes of the past 25 years, on how to fill in the gaps, and on how we can continue to improve health."
An urgent need is to tackle causes of maternal and neonatal deaths and expand coverage for HIV-positive people, she said. She added that the agency aims to help eliminate malaria from nations like Mexico, Malaysia, and South Africa and to eradicate polio and guinea worm disease globally.
Regarding universal health coverage, Chan wrote, "People want assurance that they have access to the health services they need and at a price they can afford." She said such coverage can make a strong contribution to addressing social inequality, which she called a systemic cause of poor health.
In a related commentary, Anthony Fauci, MD, and other National Institute of Allergy and Infectious Diseases (NIAID) scientists discuss how new technologies like genome sequencing and the structure-based design of vaccines and drugs might help combat emerging viral diseases like Ebola.
And experts from Emory University in Atlanta and GAVI, the Vaccine Alliance, in another commentary say that science needs to improve existing vaccines like the flu vaccine, develop new vaccines for additional diseases, and improve vaccine supply and delivery, particularly in developing nations.
Sep 10 Sci Transl Med Chan editorial
Sep 10 Sci Transl Med NIAID commentary abstract
Sep 10 Sci Transl Med commentary abstract on vaccines
Security guard for polio vaccination team in Pakistan murdered
A policeman guarding a group of polio vaccination workers in Pakistan was killed by gunmen with automatic weapons today, the latest in a series of such attacks in recent years, according to a story from the Press Trust of India (PTI).
The attack occurred in Damadola, an area in Bajaur Agency in the Federal Administered Tribal Areas (FATA) of northwest Pakistan. Dozens of members of vaccination teams and security escorts have been killed in targeted attacks there.
Polio remains endemic in only Pakistan, Afghanistan, and Nigeria, and exported cases have shown up in a number of nearby countries of late. In line with the international goal of eradicating polio worldwide, public health officials have launched mass campaigns to try to reach all young children with vaccine, but coverage, particularly in the FATA region, has remained a challenge because of resistance, attacks, and killings.
Violent factions in Pakistan see polio vaccination campaigns as foreign espionage, and many people there have been led to believe the vaccine causes infertility.
Pakistan saw 93 cases of polio 2013 and so far this year has reported 117, according to the story. The last known murder of a polio worker was in March.
Sep 10 PTI news story
