Researchers Warn: Use of Last-Resort Antibiotics on Rise at VA, Could Lead to More Hospital-Acquired Resistant Infections

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Use of carbapenems, a powerful class of antibiotic sometimes referred to as “last-resort” antibiotics has risen significantly over the last five years, according to a large study of VA hospitals.

Carbapenems are often the last treatment option for severe infections with multi-drug resistant pathogens, such as E. coli. Six approved drugs are currently in the carbapenem class, which are administered intravenously, usually in a hospital setting.

The study of antibiotic use in VA looked at barcode medication administration (BCMA) data for antibiotics administered in 110 acute-care facilities from 2005 to 2009. During the five-year period, researchers noted a gradual increase in overall antibiotic use but a striking increase in the use of carbapenems of 102%. Intravenous vancomycin use rose also 79%, and combinations of penicillin with beta-lactamase inhibitors increased 41%. Fluoroquinolenes were the most frequently used drugs across all the facilities, accounting for 20% of antibiotic use.

The carbapenem increase worries researchers because of a corresponding rise in carbapenem-resistant bacteria.

“Use of these antibiotics helps the patient receiving the treatment but has future consequences for innocent bystanders,” said study leader Makoto Jones, MD, in a statement released by The Society for Healthcare Epidemiology of America. The study was presented last month at a meeting of SHEA.

“The more these drugs are used, the more resistance we see,” Jones said.

The researchers noted that this increase in VA facilities parallels what has been observed in non-VA hospitals in the United States. According to SHEA leaders, the study represents a “clarion call” for the need to better identify pathogens and drug-resistance.

“In this era of multi-drug resistant organisms, clinicians are placed in a difficult situation. As treatment outcomes of many bacterial infections are influenced by the timing of appropriate therapy, the increasing presence of resistant organisms triggers broader use of these powerful antibiotics for proven or suspected infections when treating patients in the hospital,” said Steven Gordon, MD, president of SHEA. “Clinicians must always put the patient first in treatment decisions, but we must empower effective antibiotic stewardship programs, infection prevention and control efforts, the development of new diagnostic testing to facilitate better treatment decisions, as well as support development of new antibiotics.”

Gordon pointed out that, “Among other measures, antimicrobial stewardship ensures effective and appropriate use of the medications we have, with a focus on improving patient safety and treatment outcomes while slowing the growth of resistance.  Use of individual level data can be used to inform both the basic science and the implementation of antimicrobial stewardship programs.”

The issue has significant ramifications for the military services and VA. In announcing the availability of a new online tool showing regions of the country where antibiotic resistance is especially severe, the Robert Wood Johnson Foundation pointed out earlier this year that U.S. hospitals have seen rapid growth in resistance to the use of carbapenems to treat the Acinetobacter baumannii bacteria, with resistance increasing from less than 5% in 2000 to nearly 40% in 2009, an eight-fold increase.

The foundation noted that infection with Acinetobacter baumannii is increasingly common among troops returning home from Iraq, but, despite the high mortality rate, many infections with the bacteria cannot be effectively treated with any available antibiotics.

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