title: Vital signs: improving antibiotic use among hospitalized patients.
abstract: BACKGROUND
  Antibiotics are essential to effectively treat many hospitalized patients. However, when antibiotics are prescribed incorrectly, they offer little benefit to patients and potentially expose them to risks for complications, including Clostridium difficile infection (CDI) and antibiotic-resistant infections. Information is needed on the frequency of incorrect prescribing in hospitals and how improved prescribing will benefit patients.
  
  
  METHODS
  A national administrative database (MarketScan Hospital Drug Database) and CDC's Emerging Infections Program (EIP) data were analyzed to assess the potential for improvement of inpatient antibiotic prescribing. Variability in days of therapy for selected antibiotics reported to the National Healthcare Safety Network (NHSN) antimicrobial use option was computed. The impact of reducing inpatient antibiotic exposure on incidence of CDI was modeled using data from two U.S. hospitals.
  
  
  RESULTS
  In 2010, 55.7% of patients discharged from 323 hospitals received antibiotics during their hospitalization. EIP reviewed patients' records from 183 hospitals to describe inpatient antibiotic use; antibiotic prescribing potentially could be improved in 37.2% of the most common prescription scenarios reviewed. There were threefold differences in usage rates among 26 medical/surgical wards reporting to NHSN. Models estimate that the total direct and indirect effects from a 30% reduction in use of broad-spectrum antibiotics will result in a 26% reduction in CDI.
  
  
  CONCLUSIONS
  Antibiotic prescribing for inpatients is common, and there is ample opportunity to improve use and patient safety by reducing incorrect antibiotic prescribing. Implications for Public Health: Hospital administrators and health-care providers can reduce potential harm and risk for antibiotic resistance by implementing formal programs to improve antibiotic prescribing in hospitals.
authors.forename: Scott
authors.initials: S
authors.lastname: Fridkin
authors.forename: James
authors.initials: J
authors.lastname: Baggs
authors.forename: Ryan
authors.initials: R
authors.lastname: Fagan
authors.forename: Shelley
authors.initials: S
authors.lastname: Magill
authors.forename: Lori A
authors.initials: LA
authors.lastname: Pollack
authors.forename: Paul
authors.initials: P
authors.lastname: Malpiedi
authors.forename: Rachel
authors.initials: R
authors.lastname: Slayton
authors.forename: Karim
authors.initials: K
authors.lastname: Khader
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rubin
authors.forename: Makoto
authors.initials: M
authors.lastname: Jones
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
authors.forename: Ghinwa
authors.initials: G
authors.lastname: Dumyati
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dodds-Ashley
authors.forename: James
authors.initials: J
authors.lastname: Meek
authors.forename: Kimberly
authors.initials: K
authors.lastname: Yousey-Hindes
authors.forename: John
authors.initials: J
authors.lastname: Jernigan
authors.forename: Nadine
authors.initials: N
authors.lastname: Shehab
authors.forename: Rosa
authors.initials: R
authors.lastname: Herrera
authors.forename: Clifford L
authors.initials: CL
authors.lastname: McDonald
authors.forename: Amy
authors.initials: A
authors.lastname: Schneider
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D016360:Clostridioides difficile / Q000187:drug effects; D016208:Databases, Factual; D024881:Drug Resistance, Bacterial; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D061214:Patient Safety; D010818:Practice Patterns, Physicians' / Q000592:standards*; D017751:Safety Management / Q000458:organization & administration; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents