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April 2, 2014
Community Hospitals Often Use Inappropriate Antibiotics for Serious Bloodstream Infections
Durham, NC—Community hospitals prescribe an inappropriate antibiotic for serious bloodstream infections about a third of the time, but treatment would likely improve if clinicians were more aware of risk factors that affect therapy selection. That’s according to a new Duke Medicine study describing the challenges faced by community hospitals in treating such infections, especially in light of growing drug resistance and the high prevalence of S. aureus bacteria. Unlike most studies on bloodstream infections (BSI), the report published online by the journal PLOS ONE takes a comprehensive look at bloodstream infections in community hospitals. Much of the existing research on the condition focuses on tertiary care centers that offer highly specialized services, yet most patients seek treatment close to home, according to background in the article. “Our study provides a much-needed update on what we’re seeing in community hospitals, and ultimately, we’re finding similar types of infections in these hospitals as in tertiary care centers,” said lead author Deverick Anderson, MD, MPH, “It's a challenge to identify bloodstream infections and treat them quickly and appropriately, but this study shows that there is room for improvement in both kinds of hospital settings.” For the study, the researchers gathered information on 1,470 patients diagnosed as having bloodstream infections from nine community hospitals in Virginia and North Carolina from 2003 to 2006. The majority of the infections, 823, were determined to be community-onset, healthcare associated, with 432 patients acquiring their BSI in the community and another 215 having hospital-onset infections. The researchers determined that inappropriate empiric antimicrobial therapy was given to about 38% of patients, or they were not initially prescribed an antibiotic that was effective while the cause of infection remained unknown. Inappropriate therapy occurred more often among certain types of patients, including those who had been in a hospital or a nursing home within the past year, as well as those with impaired function and/or multidrug-resistant pathogens. Most risk factors for receiving inappropriate antibiotic therapy already are documented in electronic medical records, and Anderson recommended that clinicians in community hospitals focus on those when determining what agent to use. “Developing an intervention where electronic records automatically alert clinicians to these risk factors when they're choosing antibiotics could help reduce the problem,” Anderson said. “This is just a place to start, but it's an example of an area where we could improve how we treat patients with bloodstream infections.” The study found that the most common pathogens were S. aureus, 28%, E. coli, 24%, and coagulase-negative Staphylococci, 10%, although the type of infecting organism varied by location of acquisition. Bloodstream infections due to multidrug-resistant pathogens occurred in 23% of patients—which the report notes is an increase over earlier studies—with methicillin-resistant S. aureus (MRSA) the most common multidrug-resistant pathogen. “Similar patterns of pathogens and drug resistance have been observed in tertiary care centers, suggesting that bloodstream infections in community hospitals aren't that different from tertiary care centers,” Anderson said. “There's a misconception that community hospitals don't have to deal with S. aureus and MRSA, but our findings dispel that myth, since community hospitals also see these serious infections.”
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