Epocrates' Bugs + Drugs tool tracks local infections, combats growing antimicrobial resistance

Epocrates released Bugs + Drugs, a new tool on its mobile app showing bacterium varieties based on ZIP code, which helps clinicians better choose antibiotics and avoid worsening antimicrobial resistance.

The new tool uses bacteria found in urine, skin and other sample types based on geographic region. Clinicians can also find relevant antibiotic drug options, dosing, possible interactions and safety information through the platform.

Epocrates, a subsidiary of athenahealth, says its app is used by 1 million providers.

“With Bugs + Drugs, clinicians now have an innovative, digital tool in their pocket that offers localized susceptibility data needed to confidently make informed and effective point-of-care decisions for patients through knowledge of the bacteria prevalent in their patient’s community,” said Anne Meneghetti, M.D., executive director of medical information at Epocrates. “Better choices mean appropriately tailored care for the patient, while minimizing the impact on antibiotic resistance.”

Hospital antibiotic stewardship teams typically publish bacterial susceptibility data relevant to their inpatient setting. While those data may reveal some information about the larger community, Meneghetti believes it is not enough for clinicians to be fully informed on their local region.

Without relevant geographical data, clinicians are making empirical decisions based on their best educated guess, according to Meneghetti. Prescriptions for outpatient infections are often made before lab results return, possibly leading to misdiagnosis and fueling antimicrobial resistance in entire populations.

“The issue with antimicrobial assistance is a growing threat, and in the hospital setting we have data,” she said. “On the outpatient side, we really do not have widely available aggregated data for, ‘In this patient’s community what are the different bacteria?’ It’s simply not available.”

Bugs + Drugs collects insight from de-identified ambulatory care microbiology data within athenaClinicals, athenahealth’s electronic health record. AthenaClinicals boasts a network of over 145,000 clinicians while serving roughly 20% of the U.S. population. With such a broad reach, Epocrates expects to provide accurate, relevant bacterium data throughout the country.

Antibiotic-resistant infections exceed 2.8 million in the U.S. and are responsible for more than 35,000 deaths annually, according to a Centers for Disease Control and Prevention (CDC) pre-pandemic report. The report celebrated the progress made in addressing antibiotic-resistant infections in the preceding years, but a CDC 2022 special report revealed that such progress was lost during the pandemic.

This year’s special report showed that pandemic years brought more resistant infections, increased antibiotic use and less data and prevention actions. Of the 18 pathogens listed in the CDC’s 2019 antibiotic resistance threats in the U.S. report, nine are missing updated data, and eight are showing an increase in resistant infections of, depending on the pathogen, up to 78%.

“In the inpatient side, a lot of patients who came in with fever and pneumonia and severe COVID, three-fourths of those patients were given antibiotics, but now we know only nine percent had a bacterial infection that could have responded to antibiotics,” Meneghetti said. “On the outpatient side, we don’t really know how things have changed because we haven’t had the data.”

As the CDC reorganizes to support a population facing endemic COVID, expanding monkeypox and spreading antimicrobial resistance, Meneghetti believes Bugs + Drugs can be a resource for key data as clinicians navigate a complex infection control landscape.