When patients take too many unnecessary antibiotics it inches us ever closer to a world where essential drugs are no longer effective. More than two million people in the United States develop antibiotic resistant infection each year and some 23,000 of them die as a result. Yet understanding the origins of the problem remains a challenge. We still do not have a clear picture of physician prescribing practices nor where resistance is emerging at hospitals and within communities across the country. In part this is because it remains so time-consuming for healthcare workers to collect such information and to analyze it. Right now, only a small pool of data is passed along to the Centers for Disease Control and Prevention about what drugs are prescribed and when antibiotic resistant infections develop. There is no comprehensive data listing when such infections may have been acquired outside of the hospital or any strong baseline data indicating antibiotic resistance in specific cities or regions.
New online software launched by the Centers for Disease Control and Prevention on July 26 aims to help gather a larger slice of that data. The software will allow participating hospitals to automatically extract information about their physicians’ antibiotic prescribing practices from patient records and from test results that reveal the presence of resistant infections. The data will be gathered in bulk at participating hospitals and scrubbed of information that could be linked to individual patients or physicians.
Manually culling this sort of data and sending it to the CDC has generally been too arduous and time-consuming to be practical. Now, the agency says, hospitals can simply upload the data that the software extracts automatically or set up their systems to routinely email it to CDC through a secure system.
The only facilities set to participate in the program right away are some of the roughly 60 hospitals in the CDC’s National Healthcare Safety Network – a cadre of institutions that already voluntarily give healthcare data to CDC. Today some of the most acute antibiotic resistance problems are stoked by poor drug prescribing practices in hospitals. The goal is to get healthcare facilities to voluntarily participate in the program now so that in the coming years CDC and state health departments will be able to identify antibiotic resistance hot spots within a city or region.
“Right now we don’t have the national coverage we want. It’s not a simple flip of a switch,” says Daniel Pollack, surveillance branch chief at the CDC's Division of Healthcare Quality Promotion. “We expect over time that this will be a preferred pathway for many hospitals,” he says.
For now, all reporting will be voluntary. Hospitals that choose to participate will have immediate access to their own data, which they can analyze using their own tools or those provided by the CDC. Several years from now, when the CDC has gathered enough data nationwide, the agency hopes to provide benchmarks to compare antibiotic use and resistance across healthcare facilities.
The system will not drill down to specify in its records if the infection was acquired in the community versus the hospital. Nor will the system sequence the DNA of resistant pathogens to help map out their geographic origins. But gathering more information will, at least, give CDC a better sense of the scope of the problem.
“If we are not careful we will soon be in a post-antibiotic era, and for some patients and some microbes we are already there,” CDC director Tom Frieden said in a speech in Washington, D.C. last week. “Every day we delay means it will be harder and more expensive to fix this problem in the long run.”