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More Antibiotic Stewardship Needed at Smaller Hospitals

SALT LAKE CITY, UT – When it comes rates of antibiotic use at hospitals, size doesn’t seem to matter much.

That’s why enhancing antimicrobial stewardship programs to ensure appropriate use of antibiotics in smaller community hospitals – 70% of all hospitals in the United States have fewer than 200 beds -- is essential to combat the global threat of antibiotic-resistant bacteria, according to a study in Clinical Infectious Diseases.

Researchers from Intermountain Medical Center and colleagues found that, although antibiotic use rates in small community hospitals are similar to large community and academic-based hospitals, many community hospitals have limited access to resources required to develop effective antimicrobial stewardship programs. That is especially significant because new national hospital standards require all hospitals to have programs established by 2017, according to the study authors.

"Most of the existing data on antibiotic use rates comes from larger academic medical centers," explained Eddie Stenehjem, MD, an infectious disease physician and researcher at Intermountain Medical Center, the flagship facility for the Intermountain Healthcare system. "Our study highlights antibiotic prescribing patterns in small hospitals, and we found them to be similar to large hospitals in terms of overall rates and antibiotic spectrum used."


The study included data from 2011 to 2013 – obtained from the CDC’s Antibiotic Use Module of the National Health and Safety network – on antibiotic use at four large hospitals and 15 small community hospitals within the Intermountain Healthcare system.

The results indicate that antibiotic use rates varied widely across the 15 small community hospitals, although they were similar to rates in the four larger hospitals. Researchers found that broad-spectrum antibiotics accounted for 26% of use in the small hospitals, in line with the 32% rate in the larger hospitals.

"In order to holistically address the growing problem of antibiotic-resistant bacteria, the infectious disease community must respond to antibiotic use in all hospitals, not just the large academic medical facilities," Stenehjem said. "Small hospitals are least likely to have stewardship programs even though antibiotic usage patterns are similar to larger facilities. We need to bring stewardship support to all hospitals, but the challenges come in knowing how to do that."