Antimicrobial Use in Hospitals: Managing a Medical Treasure

Robert Gaynes, MD


November 12, 2007


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Antimicrobial agents are a remarkable class of drugs. While responsible for some of the most dramatic improvements in medical therapy in history, these medicines are also the only class of drugs whose efficacy diminishes with wide-scale use.

We all know that antimicrobial resistance is the reason for deceases in the effectiveness of antimicrobials. Antimicrobial resistance is worsening. Resistance is particularly prevalent in hospitals, especially in intensive care units (ICUs) where some pathogens already are untreatable.[1] Infection control efforts, while vital, are not sufficient. We must optimize our antimicrobial use for these 3 reasons.

First, the cost of antimicrobials is high, comprising as much as 20% to 30% of a hospital's pharmacy budget, and the newer agents are usually the most expensive.

Second, once antimicrobial resistance takes hold in a facility, so-called second-line agents are often less effective and can be more toxic.

Third, the supply of antimicrobial agents is decreasing.

Nearly all antimicrobial resistance can be traced to antimicrobial use. Over 50% of hospitalized patients and over 85% of ICU patients receive an antimicrobial. Do they all really need them? Various studies show that between 30% and 70% of antimicrobial use in hospitals is inappropriate. To optimize antimicrobial use, we must address multiple concerns. Some hospitals accomplish this with a team approach. Computerized decision support offers the single best approach for optimization[2] and should be made available.

In order to continue to use these agents, we all must learn when to use and when not to use antimicrobials. Good antimicrobial stewardship considers more than the immediate benefit to the individual patient being treated; it considers the long-term effects of antimicrobial use. We must all do our part to preserve these medical treasures. Just imagine the alternative -- practicing medicine without antimicrobial agents.

That's my opinion. I'm Dr. Robert Gaynes of the CDC and an Associate Professor at Emory University School of Medicine.




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