CDC, EU reports highlight need to improve antibiotic use

Separate reports released by the CDC and three European agencies demonstrated poor antibiotic prescribing practices in health care settings and an association between antimicrobial consumption and resistance in humans and food-producing animals.

Both the CDC report, “Antibiotic Use in the United States 2017; Progress and Opportunities,” and the Joint Interagency Antimicrobial Consumption and Resistance Analysis (JIACRA), published by the European Centre for Disease Prevention and Control (ECDC), European Food Safety Authority (EFSA) and European Medicines Agency (EMA), state that the findings underscore the need to improve unnecessary antibiotic use to reduce resistance.

“Efforts to improve antibiotic use will succeed only if everyone plays a role,” the CDC report said. “Success will depend upon coordinated efforts to promote and adopt principles of responsible antibiotic prescribing and use across the globe, from government agencies, foundations, professional organizations, companies, health systems, hospitals, clinics, nursing homes, patients and health care providers.”

The CDC reviews antibiotic use in health care settings

According to the CDC, antibiotic use in the community and health care settings has improved in the United States. From 2011 to 2014, antibiotic prescribing decreased 5% in outpatient settings. However, the agency still estimates that 30% of antibiotic prescriptions in outpatient clinics are unnecessary.

“Even when antibiotics are needed, prescribers often favor drugs that may be less effective and carry more risk over more targeted first-line drugs recommended by national guidelines,” the report said.

The CDC also estimates that one-third of antibiotic prescriptions in U.S. hospitals are unnecessary or prescribed incorrectly. A 2016 study conducted by CDC researchers found that use of the “most powerful” antibiotics significantly increased in hospitals from 2006 to 2012. During that time, there was a 37% rise in carbapenem use and a 32% rise in vancomycin use. Data from the CDC’s National Healthcare Safety Network also demonstrated substantial variation in prescribing practices, with health care providers in some hospitals prescribing up to three times as many antibiotics as providers in other hospitals from similar areas.

Although more data are needed to fully determine antibiotic use in nursing homes, the report stated that 50% to 70% of nursing home residents receive an antibiotic over the course of a year, and up to 75% of prescriptions are incorrect. A small CDC analysis involving nine facilities in four states showed that 11% of residents received antibiotics on any single day, and 38% of orders lacked important documentation on prescribing elements. A larger study involving partnerships with nursing home networks, pharmacies and other companies is currently underway to further explore areas where action is most needed.

According to the report, acute respiratory infections are the primary cause of inappropriate antibiotic use in outpatient settings. Meanwhile, in nursing homes and hospitals, urinary tract infections and pneumonia are the leading conditions that warrant improvements in antibiotic prescribing. The agency provided a number of resources that health care professionals can use to improve antibiotic prescribing, including The Core Elements of Antibiotic Stewardship Programs and similar tools specifically for outpatient clinics, nursing homes and small and critical access hospitals.

European agencies examine link between antimicrobial use in animals, resistance

Although the CDC report focused on antibiotic use and prescribing practices in health care settings, the CDC said that stewardship efforts in agriculture and animal health are also important. This was addressed in a recent JIACRA report, which linked antimicrobial use in humans and food-producing animals to an increasing prevalence of antimicrobial-resistant bacteria.

The report examined data from countries affiliated with the European Union (EU) from 2013 to 2015. Overall, the ECDC, EFSA and EMA found that antimicrobial consumption (AMC) was higher in people than food-producing animals. Multivariate analyses revealed that Escherichia coli with resistance to third- and fourth-generation cephalosporins and fluoroquinolones in humans was associated with AMC in humans. Meanwhile, Salmonella spp. and Campylobacter spp. with resistance to fluoroquinolones in humans was associated with AMC in animals.

“These results suggest that from a ‘One Health’ perspective, there is potential in both sectors to further develop prudent use of antimicrobials and thereby reduce [antimicrobial resistance],” the report said.

In univariate analyses, there were significant associations (P < .05) between AMC in both humans and animals and resistance to fluoroquinolones in humans and animals with E. coli; third- and fourth-generation cephalosporins in humans with E. coli; and tetracyclines and polymyxins in animals with E. coli. AMC in humans was also significantly associated with resistance to carbapenems and polymyxins in humans with Klebsiella pneumoniae, and AMC in animals was associated with resistance to macrolides in animals and humans with Campylobacter coli.

“This new report confirms the link between antibiotic consumption and antibiotic resistance in both humans and food-producing animals,” European Commissioner for Health and Food Safety Vytenis Andriukaitis, said in a press release. “To contain antibiotic resistance, we need to fight on three fronts at the same time: human, animal and the environment. This is exactly what we are trying to achieve in the EU and globally with our recently launched EU Action Plan on antimicrobial resistance.” – by Stephanie Viguers

References:

CDC. Antibiotic Use in the United States, 2017: Progress and Opportunities. https://www.cdc.gov/getsmart/stewardship-report/. Accessed August 2, 2017.

European Centre for Disease Prevention and Control. EFSA Journal. 2017;doi:10.2903/j.efsa.2017.4872.

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