Each year, nearly 2 million patients in the United States get an
infection as a result of receiving health care in a hospital. These hospital-acquired
infections are often difficult to treat because the bacteria and other microorganisms that
cause them frequently are resistant to antimicrobial drugs.
Bacteria, fungi, and even viruses can become resistant to drugs.
However, bacteria cause most of the drug-resistant problems in hospitals. Bacteria can
become resistant to antibiotics in a variety of ways. And once a particular type of
bacteria has developed resistance to a drug, it can pass on this resistance to other types
Overall, 70% of the bacteria causing such infections are resistant to
at least one of the drugs most commonly used to treat these infections. In some cases,
these organisms are resistant to all approved antibiotics and must be treated with
experimental and potentially very toxic drugs.
The more often a drug is used, the more likely bacteria are to develop
resistance to it. For this reason, and to combat the problem of drug-resistant bacteria,
CDC has developed recommendations to help ensure that drugs are prescribed only when
appropriate. These recommendations, together with other CDC guidelines for infection
control, should help limit the spread of drug-resistant infections in the nation's
What has been the impact of antibiotic resistance on the problem of
Antibiotic resistance is a major contributor to the disease,
death, and costs resulting from hospital-acquired infections. Unfortunately, the precise numbers are not known. There is a great need for studies in this area. One report placed
the annual cost of antimicrobial resistance among a single pathogen (Staphylococcus
aureus) at $122 million.
What's being done about this?
CDC and other healthcare organizations, such as the Society for
Healthcare Epidemiology of America, the Association for Professionals in Infection Control
and Epidemiology, the Infectious Diseases Society of America, and the American Academy of
Pediatrics, are working to improve antimicrobial prescription practices. For example, a national videoconference for healthcare workers to improve the use of
vancomycin, a first-line drug used to combat serious staphylococcal and enterococcal
infections was recently held. Another videoconference on antimicrobial use will be held later this year. Plus, guidelines are being made available in new ways, e.g., over the Internet.
Do doctors overprescribe antibiotic drugs in hospital and health care settings?
CDC and other healthcare organizations have developed guidelines for
the use of antibiotics in hospitals; however, some research indicates that antibiotics are
being used more than the guidelines recommend. For example, one recent study indicated
that as much as 60% of the hospital prescriptions for one of these drugs, vancomycin, are
not in accordance with the guidelines.
What are the most common patient mistakes with antibiotics?
Asking for antibiotics they don't need, e.g., as treatment for viral
infections, such as colds, which don't respond to antibiotics. Not taking antibiotics as
prescribed, especially stopping before the prescription runs out (thus, they may not kill
all the infecting organisms and they leave the most resistant ones behind to continue to
grow). Saving antibiotics and later self-prescribing them.
What should a hospital do to address the problem of antimicrobial resistance?
The hospital should monitor antibiotic use and resistance, provide
guidelines for antimicrobial use and for preventing the spread of resistant bacteria
within the hospital, and monitor compliance with these guidelines.
Are most doing this?
Because there are no current standards for antibiotic use such as those
the Joint Commission on Accreditation of Healthcare Organizations sets for infection
control, there is not a clear picture on this. But it is estimated that the percentage of hospitals
with adequate programs for monitoring antimicrobial use and resistance is much smaller
than the percentage with effective infection control programs.