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May 2014

Why Does Antimicrobial Overuse in Hospitalized Patients Persist?

Author Affiliations
  • 1Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
  • 2Department of Medicine, University of Michigan Medical School, Ann Arbor
JAMA Intern Med. 2014;174(5):661-662. doi:10.1001/jamainternmed.2014.897

God gave the world to men in common; but since he gave it to them for their own benefit…it cannot be supposed he meant it should always remain common….

John Locke, Second Treatise of Government, 1689

…you are undone if you once forget that the fruits of the earth belong to us all, and the earth itself to nobody.

Jean-Jacques Rousseau, Discourse on Inequality, 1754

The overuse of antimicrobials leads to the development of bacterial resistance and makes patients susceptible to Clostridium difficile and other serious infections, yet many hospitalized patients continue to receive antimicrobials that are inappropriate or unnecessary.1 In a new study in Morbidity and Mortality Weekly Report, Fridkin and colleagues,2 using administrative data from 323 hospitals in the United States, found that 55.7% of inpatients received antimicrobials. Furthermore, using data from the Emerging Infections Program at the Centers for Disease Control and Prevention (CDC) and applying objective criteria for “potential improvement” in antimicrobial use at 36 hospitals, they report opportunities for improvement in the use of these medications in 37% of patients receiving vancomycin or treatment for urinary tract infection (UTI). It is disheartening that despite years of work, little progress has been made.3 In fact, Alexander Fleming warned against the overuse of penicillin in 1945.4 Nearly 70 years later, however, his call is being repeated. Why?

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