"But what we saw in our analysis is that there is a very large number of patients who had vancomycin started initially, had cultures obtained, but then three days later the patients were still on vancomycin, even though the culture results did not reveal MRSA.
"But we also know that there are times when patients are started on antibiotics, but there was no evidence of a patient having symptoms of infection. For urinary tract infections, guidelines tell us that before you treat a patient for a urinary tract infection, they should have both bacteria in their urine and some symptoms that go along with a diagnosis."
In the CDC study, he says, "we saw a large number of instances where there was bacteria in the urine—so half of the equation was there—but there was no evidence the symptoms were present."
A Condition for Hospital Accreditation
I asked Srinivasan why antibiotic stewardship practices don't already exist in all hospitals. Doesn't the Joint Commission require such programs as a condition for accreditation?
He replied, "No, they do not."
But shouldn't they? Srinivasan says, "That's an important area for more discussion, and something we're interested in talking about. Certainly the Centers for Medicare and Medicaid Services recognizes the importance of the need to improve antibiotic use, and we are engaged in discussions with them for different options to make that a reality."
Hmmm. Perhaps a pay for reporting measure is down the road. Something like, "Hospital always pauses antibiotic prescription after 48 hours to determine drug appropriateness. Yes? No?" Readers, what do you think?