Blog | Friday, April 18, 2014

Antimicrobial overuse: A tragedy of the commons?


The CDC released a report on antimicrobial use practices in U.S. hospitals that confirms what many already suspect: antibiotics are overused and/or used incorrectly a large percentage of the time. The details are summarized in the MMWR report and accompanying Vital Signs.

Eli Perencevich, MD, ACP Member, just posted on our post-antibiotic era, and we will undoubtedly have more to say about this later. For now, though, I’ll outsource to this excellent commentary by Scott Flanders and Sanjay Saint in JAMA Internal Medicine. I have a minor quibble with any construction of this problem as a kind of “tragedy of the commons,” where rational decisions to improve individual health run counter to the interests of society. Inappropriate or unnecessary antibiotic use hurts both the treated individual and society. Moreover, the most persuasive arguments for improving antibiotic use are those that appeal to improving individual patient outcomes (rather than to saving money or reducing resistance rates in aggregate).

Finally, the clinical microbiologist in me can’t help but emphasize one of the greatest obstacles to optimizing antimicrobial therapy: the absence of rapid and accurate diagnostics. On that note, here is some bedtime reading.

Daniel J. Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. This post originally appeared at the blog Controversies in Hospital Infection Prevention.