Public Health Impact of

Antibiotic Resistance

Steven L. Solomon, MDDirector, Office of Antimicrobial Resistance

Centers for Disease Control and Prevention

Symposium: Bridging the Gap Between

Animal Health and Human Health

November 12, 2013Kansas City, Missouri

Fighting back against antibiotic resistance

Antibiotic use and misuse

• Up to 50% of antimicrobial use in hospitals

is unnecessary or inappropriate

• Up to 20% in a recent pediatric survey

Antimicrobial Usage Rates and Standardized Utilization Ratios (SURs)

Antibiotic Days (Total)

InterpretationObserved Predicted SUR

MICU 4000 1000 4.0 Excessive

SICU 2000 2000 1.0 Consistent

Medical Ward 3000 4000 0.75 Lower Use

Surgical Ward 1000 3000 0.33 Much Lower

Hospital 170,250 171,000 0.99 Consistent

Mock-up of Hospital Antimicrobial Use Monitoring:Benchmarking of Antimicrobial Use To Guide Stewardship

SUR is a ratio of the actual usage compared to predicted

Antibiotic best practices

1. Ensure all orders have dose, duration, and indications

2. Get cultures before starting antibiotics

3. Take an “antibiotic timeout,” reassessing antibiotics after 48-72 hours

Improving antimicrobial use

• Prescriber- and facility-based strategies– Formulary restriction– Prior approval– “Time-out” programs– Education, benchmarking

• Consider improved use measures as part of: – State licensure for healthcare facilities– Hospital accreditation– Reimbursement from third party payers

Summary• All antibiotic use contributes to the

development of resistance

• Antibiotic use in all settings can be

improved

• Both reducing antibiotic use and using

antibiotics with greater care in all settings

will improve human health

• www.cdc.gov/drugresistance

• www.cdc.gov/drugresistance/threat-report-

2013