Penn hospital at the forefront of antibiotic-resistance fight

When an infection won’t respond to any available antibiotics, drug-resistant genes can turn deadly.

Picking up drug-resistant genes is becoming common for many types of bacteria, especially in hospitals. The Centers for Disease Control and Prevention has released a new Vital Signs report to bring attention to the increasing problem, which can turn deadly when an infection simply won’t respond to any available antibiotics.

CDC Director Tom Frieden said the report found that about half of all hospitalized patients receive antibiotics during their stay. 

“Given the many reasons patients need hospital care, that’s not particularly surprising,” he said. “But what did really surprise me is that doctors in some hospitals prescribe three times as many antibiotics as others, even though the patients were being cared for in similar areas of each hospital.”

Excessive prescribing, especially without paying attention to how well it’s working, is exactly what drives antibiotic resistance. The good news is that in many cases, reducing antibiotic use is likely to be effective. A 26 percent cutback in antibiotics used to treat Clostridium difficile reduced those often deadly infections by 30 percent.

“That’s almost a one-to-one impact,” said Frieden, “a huge impact on patient safety.”

The CDC also wants all hospitals to start their own antibiotic stewardship programs. The Hospital of the University of Pennsylvania was one of the first to have such a program more than 20 years ago, and helped develop some of the CDC’s core prescribing practices.

Keith Hamilton, director of antibiotic stewardship at the University of Pennsylvania, said his hospital has an electronic system that will alert doctors if it identifies inappropriate antibiotic prescriptions.

“It allows us to, essentially, act as the antibiotic police,” he said.

But Hamilton has also been designing solutions for smaller hospitals with fewer resources.

“The tool is meant to be a reference, a resource — essentially a checklist for the provider,” he said. “It’s a low-tech way of promoting judicious antibiotic use.”

With the checklist, a doctor must document a reason to use an antibiotic, and also reassess the need a day or two later, including the results of the appropriate lab tests.

To help get more hospitals up to speed, the CDC also announced a $30 million proposal for its Advanced Molecular Detection Initiative, which would double the funding for combating antibiotic resistance.

“One of the things that makes us so focused on antimicrobial resistance, is not only is it a really serious problem, but it’s not too late,” Frieden said. “We can reverse drug resistance.”

The CDC pointed to the success of other countries, including the United Kingdom, which has been able to reduce their C. difficile infections by about 70 percent in the past six to seven years. Frieden argued that if the CDC gets that funding and hospitals follow through with their recommendations, the United States would be able to cut infections by both C. difficile and carbapenem-resistant enterobacteriaceae (CRE) — a less well known, but even more lethal bacteria — in half in the next five years.