Roughly one-third of the antibiotic prescriptions written in U.S. outpatient offices – an estimated 47 million scripts annually – are for viral illnesses that cannot be treated with antibiotics.
According to the U.S. Centers for Disease Control and Prevention, 270.2 million outpatient antibiotic prescriptions were written in 2016. That number is up from the 266.1 million reported in 2014 – or what amounted to roughly five prescriptions written that year for every six people in the country.
The CDC estimates that one in two hospital patients receive an antibiotic for at least one day during an average hospital stay. Approximately 30 percent of those antibiotics should not have been prescribed because they were unnecessary, proper testing was not done to determine the right antibiotic, or the drug was given for too long, the CDC reported in its 2018 Antibiotic Prescribing and Use in U.S. progress report. Additionally, the Pew Antibiotic Resistance Project reported that of the of the 154 million visits made to U.S. outpatient offices in 2015, 13 percent resulted in an antibiotic prescription.
Antibiotics and AMR
Overprescribing antibiotics is not new to health care. The Society for Healthcare Epidemiology of America (SHEA) reports that as early as 1968, roughly 50 percent of antibiotic use was not medically necessary or appropriate.
The more antibiotics are used, the less likely they are to be effective, and the more antimicrobial resistance (AMR) will spread. Whether bacteria evolve gradually or quickly in a given course of treatment, all antibiotic use contributes towards global AMR. It also puts individual patients at risk of severe side effects and allergic reactions. Or they could fall victim to C. difficile, which often happens when antibiotics kill off too much “good” gut bacteria.
How does this connect to bronchoscopy? Because as antimicrobial resistance continues to spread around the globe, hospital-acquired infections caused by contaminated medical devices pose a greater risk to patients. It’s more difficult and expensive to cure infections caused by antimicrobial-resistant organisms than ever before – and more infections have been traced back to flexible endoscopes than any other medical device.
How Serious is the Threat?
In a 2019 survey or more than 300 physicians, 99 percent of those surveyed recognized AMR as a national problem. Only 63 percent of those physicians, however, viewed it as a problem within their own facility. This suggests many see the risk of AMR as a distant, theoretical problem rather than an imminent threat, the survey authors said.
The survey, “Physicians’ attitude and knowledge regarding antibiotic use and resistance in ambulatory settings,” was published in the American Journal of Infection Control in 2019, led by Amanda Harris of Wayne State University and Detroit Medical Center.
Underestimating AMR’s true threat might explain why 16 percent of the 323 surveyed physicians said they prescribed antibiotics more often than they should. This despite 94 percent of respondents agreeing that every antibiotic prescription can have an impact on AMR. Aggressive prescribing is necessary to avoid clinical and economical failures, 23 percent of the physicians said.
“This again indicates that many respondents perceive the risk of AMR as not real, the factor that might impede the process of behavioral change,” the authors write.
What Do Patients Expect?
In a culture where patients expect to walk out of a doctor’s office with a medicine to cure what ails them, AMR thrives. “Patient expectations” is one of the driving factors behind the overabundance of antibiotic prescriptions, the survey found. More than two-thirds of the respondents perceived patients’ expectations as an important cause of AMR.
“Cultural beliefs of patients were found to be an important host factor influencing the prescribing behavior of primary-care physicians,” according to the authors.
In a series of posts, we’re exploring these questions around antimicrobial stewardship strategies and in the coming weeks we’ll talk to experts about:
- Stewardship: The CDC, SHEA, and APIC all provide suggested best practices for antimicrobial stewardship. Do their recommendations go far enough to address the risk from medical devices?
- The role of infection prevention: Infection prevention should play a greater role in antimicrobial stewardship.
- Challenges and innovations: Reprocessing a flexible endoscope is a long and arduous process, prone to errors. There are, however, some innovations that help curb contamination risk.
- Leadership: Typically, physicians who prescribe antibiotics spearhead antimicrobial stewardship. But bedside nurses are just as important to the strategy, especially in the OR and ICU.
- Conclusions: Effective antimicrobial stewardship should address all levels of infection prevention and control, including the proper handling of bronchoscopes.