Improving antibiotic use in hospitals: A cornerstone approach to prevention of antibiotic resistance

Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable. Many medical advances are dependent on the ability to fight infections using antibiotics, such as cancer chemotherapy and organ transplantation. For sepsis, an extreme life-threatening response by the body to an infection, it is important that antibiotics are initiated promptly to treat the infection that can lead to sepsis, which reduces morbidity (illness) and saves lives.

However, around 30% of all antibiotics prescribed in United States acute care hospitals are either unnecessary or inappropriate in selection, dose, or duration. Any medication can have serious side effects. For antibiotics, those side effects can include adverse drug reactions and Clostridioides difficile infection (CDI, previously called Clostridium difficile infection). While antibiotics save lives, overusing them can lead to antibiotic resistance—when germs develop the ability to defeat the drugs designed to kill them. CDC estimates more than 2.8 million people are infected with antibiotic-resistant organisms, resulting in more than 35,000 deaths annually.

Evidence demonstrates that hospital-based programs dedicated to improving antibiotic use, commonly referred to as antibiotic stewardship programs (ASPs), can both optimize the treatment of infections and reduce adverse events associated with antibiotic use. These programs help clinicians improve the quality of patient care and improve patient safety through optimizing the use of antibiotics, resulting in increased infection cure rates and reduced treatment failures. They can also significantly reduce hospital rates of C. difficile infections and antibiotic resistance. In recognition of the urgent need to improve antibiotic use in hospitals and the benefits of antibiotic stewardship programs, in 2014 CDC recommended that all acute care hospitals implement antibiotic stewardship programs and CDC released Core Elements of Hospital Antibiotic Stewardship to support implementation. In 2019, CDC updated the hospital Core Elements to reflect both lessons learned from five years of experience as well as new evidence from the field of antibiotic stewardship.

CDC's Core Elements of antibiotic stewardship provide frameworks for antibiotic stewardship implementation in outpatient settings, nursing homes, and hospitals, including small hospitals in rural areas. Hospitals report information about their antibiotic stewardship programs and whether they meet each of CDC's Core Elements in CDC's National Healthcare Safety Network (NHSN) annual survey. The number of hospitals with antibiotic stewardship programs that meet all 7 Core Elements has increased markedly in recent years, seen below (Antibiotic Stewardship Profile: Changes Over Time):

However, there is still work to be done. The map below shows the variability in implementation of all 7 core elements of antibiotic stewardship programs by hospitals across the United States in 2020 (Antibiotic Stewardship Profile: Location):

CDC works with public health and healthcare partners including health systems, hospital associations, professional organizations, academic investigators, private industry, patient and consumer organizations, state and local health departments, and federal partners to promote and facilitate implementation of the Core Elements. For example, CDC worked with local, state, and national experts to create the National Quality Partners Playbook: Antibiotic Stewardship in Acute Care, a practical guide to help hospitals and health systems of all sizes implement the Core Elements. When annual survey data indicated that smaller hospitals were less likely to implement all of the Core Elements, CDC worked with rural health, hospital, and federal partners to tailor the Core Elements to support implementation in small hospitals and address their specific needs. CDC is also working to better characterize the impact of antibiotic stewardship interventions on resistance. As more hospitals engage in efforts to optimize antibiotic use, future work is needed to evaluate which interventions or antibiotic targets yield the greatest benefit in combating antibiotic resistance.

Explore stewardship data in your state's profile page.