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Inappropriate Antibiotic Use Costing U.S. $163 Million

3-D image of MRSA bacteria

3-D image of MRSA bacteria (Melissa Brower, CDC)

11 September 2014. A review of hospital records over 4 years identifies widespread overuse of antibiotics, leading to an estimated $163 million in annual avoidable costs in the U.S. The study by analysts from Premier, a corporate health care industry alliance in Charlotte, North Carolina, and Centers for Disease Control and Prevention in Atlanta appears in the October issue of the journal Infection Control and Hospital Epidemiology.

The overuse of antibiotics is a well-documented public health issue leading to increasingly resistant microbes and avoidable harm to patients. The researchers, led by Leslie Schultz of Premier’s safety institute, sought to put a price tag on the practice and identify the leading culprits to help ease the burden on hospitals and those paying the bills.

Schultz and colleagues analyzed de-identified patient discharge records of 505 hospitals in the U.S., all of which were outside U.S. federal health care systems (e.g., Veterans Administration) for the years 2008 through 2011. The researchers looked specifically for potentially redundant combinations of prescriptions of antibiotics, divided into 3 categories:

–  Antianaerobics, to combat bacteria that grow in the absence of oxygen, such as those causing abdominal infections (e.g., C. difficile), abscesses, and periodontitis

– Treatments for Methicillin-resistant Staphylococcus aureus (MRSA)

– Dual beta-lactam antibiotics, such as penicillin

The search yielded 32,507 instances of redundant administration of antibiotics, defined as coverage for the same organisms with 2 agents for at least 2 consecutive days during a single hospital stay. The results show potentially inappropriate use of redundant antibiotics in 23 different combinations of drugs at 78 percent of the hospitals (394 of 505) sampled.

In addition, the researchers found 3 antianaerobic combinations that accounted for 22,701 or 70 percent of redundant cases. And one of these combinations — metronidazole and piperacillin-tazobactam — alone accounted for more than half (53%) of the redundancies. Both of the antibiotics are prescribed to treat infections of the vagina, gastrointestinal tract, and skin.

Costs for administration of redundant drugs were calculated by the pharmacy prices billed to patient and the charges for administering the drugs, such as time billed for the clinicians. For the 505 hospitals in the sample, the total cost of the redundant antibiotic drugs over the 4 years came to more than $12 million. Extrapolating these avoidable costs to all U.S. hospitals for a single year, 2012, the authors estimate redundant antibiotics raised health care costs by $163 million.

Schultz notes in a Premier statement that often redundant antibiotics are often prescribed for the best of reasons. “Sometimes in an effort to ‘do whatever it takes’ to fight a serious infection, clinicians use multiple antibiotics to treat the same infection,” says Schultz. “We hope these findings help to enhance the antimicrobial stewardship initiatives that the majority of U.S. hospitals already have in place today.”

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