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Why Does Antimicrobial Overuse in Hospitalized Patients Persist?

Scott A. Flanders, MD2; Sanjay Saint, MD, MPH1,2
[+] Author Affiliations
1Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
2Department of Medicine, University of Michigan Medical School, Ann Arbor
JAMA Intern Med. 2014;174(5):661-662. doi:10.1001/jamainternmed.2014.897.
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The overuse of antimicrobials leads to the development of bacterial resistance and makes patients susceptible to Clostridium difficile and other serious infections, yet many hospitalized patients continue to receive antimicrobials that are inappropriate or unnecessary.1 In a new study in Morbidity and Mortality Weekly Report, Fridkin and colleagues,2 using administrative data from 323 hospitals in the United States, found that 55.7% of inpatients received antimicrobials. Furthermore, using data from the Emerging Infections Program at the Centers for Disease Control and Prevention (CDC) and applying objective criteria for “potential improvement” in antimicrobial use at 36 hospitals, they report opportunities for improvement in the use of these medications in 37% of patients receiving vancomycin or treatment for urinary tract infection (UTI). It is disheartening that despite years of work, little progress has been made.3 In fact, Alexander Fleming warned against the overuse of penicillin in 1945.4 Nearly 70 years later, however, his call is being repeated. Why?

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Biofilms and Susceptibility tests
Posted on March 4, 2014
James G Timourian
Innovotech Inc.
Conflict of Interest: James Timourian is a shareholder in and the President of Innovotech Inc., whose products are directly related to the comment.
If the right antimicrobial product was selected the first time, organisms would have less ability to develope resistance. Many infections involve bacteria in a difficult to kill biofilm state. There are susceptibility tests that are approved in Canada that test antibiotics against specific biofilms. There also is a standard device (the MBEC Assay) that can be used to grow biofilms and test antimicrobials for effectiveness. If these tests were in wider use they would cut down the excessive use of antimicrobial products in hospitals.
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