Antimicrobial Expenditures and Usage at Four University Hospitals (original) (raw)
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Infection
The increasing use of antimicrobial drugs is resulting in enormous hospital expenditures. Careful assessment of inappropriate prescribing and a search for more cost-effective treatment strategies are urgently required. Comparisons between hospitals should help identify areas of inappropriate prescribing as well as effective drug use programs, but such analyses may be severely biased if the impact of different case-mixes is not recognized. Patients and Methods: We studied antimicrobial usage and expenditures at four state university hospitals in southwestern Germany and assessed the significance of differences between hospital services after adjustment for patient variables. A prevalence survey was done with review of 2,254 charts of patients admitted to the surgical, medical and pediatric services to obtain information on antimicrobial drug prescription and expenditures in the week preceding the survey. Results: According to pharmacy data for the year 1994, maximal differences between these hospitals in the antibiotic costs per patient-day were 1.9-fold (surgical services), 1.5-fold (medical services), and 1.6-fold (pediatric services). In a multivariate analysis, adjusted antibiotic prescription prevalence rates did not differ for medical and pediatric service patients, but did differ for surgical service patients (p = 0.03). Similarly, adjusted expenditures per patient-week differed significantly between hospitals for surgical service patients (p = 0.001), but only marginally for medical (p = 0.14) and pediatric (p = 0.05) service patients. The adjusted difference in expenditures between surgical departments was as large as 2.8-fold (95% CI 1.8 to 4.3) and was primarily related to preferential use of expensive iv antimicrobial drugs. Conclusion: In two hospitals, lowest expenditures in either surgery or medicine were associated with active antimicrobial drug use programs suggesting an impact of these programs on drug use and expenditures limited to these services. The identification of such large patient-mix unrelated differences in antimicrobial usage and expenditures offers opportunities for quality improvements and cost reduction. Figure 3
Antimicrobial resistance and infection control, 2014
Surveillance data of antibiotic use are increasingly being used for benchmarking purposes, but there is a lack of studies dealing with how hospital- and patient-related factors affect antibiotic utilization in hospitals. Our objective was to identify factors that may contribute to differences in antibiotic use. Based on pharmacy sales data (2006-2011), use of all antibiotics, all penicillins, and broad-spectrum antibiotics was analysed in 22 Health Enterprises (HEs). Antibiotic utilization was measured in World Health Organisation defined daily doses (DDDs) and hospital-adjusted (ha)DDDs, each related to the number of bed days (BDs) and the number of discharges. For each HE, all clinical specialties were included and the aggregated data at the HE level constituted the basis for the analyses. Fourteen variables potentially associated with the observed antibiotic use - extracted from validated national databases - were examined in 12 multiple linear regression models, with four differ...
Analysis of antimicrobial consumption and cost in a teaching hospital
Journal of Infection and Public Health, 2014
Background: The aim of this study is to compare the periods before and after the intervention applied using the ATC/DDD method in order to ascertain the rational use of antibiotics in a newly established hospital. Method: The appropriateness of the hospital's antibiotic use, consumption rates and the costs were calculated and compared with other hospitals. Based on these data, an intervention has been planned in order to raise the quality of antibiotic use. The periods before and after the intervention were compared. Between 16 May 2011 and 23 May 2012, data were collected from all hospital units by the infectious diseases specialists and a point prevalence survey was conducted. Anatomical therapeutic chemical classification and the defined daily dose (DDD) methodology were used to calculate the antibiotic consumption. Results: On two specific days in 2011 and 2012, 194 out of 307 patients (63.2%) and 224 out of 412 patients (54.4%) received antibiotic treatment, respectively. In 2011 and 2012, the percentage of appropriate antibiotic use was 51% and 64.3%, respectively. Both in 2011 and 2012, inappropriate antibiotic use was found to be significantly higher in surgical clinics in comparison to the internal diseases clinics and the ICU. This was caused by the high rates of inappropriate perioperative antimicrobial prophylaxis observed in surgical clinics. During both years, approximately one-third of the antibiotics were prescribed for the purposes of perioperative prophylaxis, while 88.5% and 43.7% of these, respectively, were inappropriate and unnecessary. Cephalosporins, fluoroquinolones, combinations of penicillins
Benchmarking antimicrobial drug use at university hospitals in five European countries
Clinical Microbiology and Infection, 2007
A point-prevalence survey of five European university hospitals was performed to benchmark antimicrobial drug use in order to identify potential problem areas in prescribing practice and to aid in establishing appropriate and attainable goals. All inpatients at the university hospitals of Rijeka (Croatia), Tartu (Estonia), Riga (Latvia), Vilnius (Lithuania) and Karolinska-Huddinge (Sweden) were surveyed for antimicrobial drug use during a single day. The frequency of antimicrobial drug use was 24% in Rijeka, 30% in Tartu, 26% in Riga, 14% in Vilnius and 32% in Huddinge. Surgical patients were treated with antimicrobial agents more often than medical patients in Riga (53% vs. 31%), Tartu (39% vs. 26%) and Vilnius (54% vs. 25%). Two-thirds of patients in Rijeka, Tartu, Riga and Vilnius, and fewer than half of the patients in Huddinge, received antimicrobial agents intravenously. Broad-spectrum antimicrobial agents were used most commonly in Rijeka. The prevalence of nosocomial infections treated with antibiotics was 9% at Huddinge, and 3-5% at the other centres. Benchmarking antimicrobial drug use at five university hospitals identified differences and problem areas. The high rates of intravenous administration, poor compliance with guidelines, and prolonged surgical prophylaxis were general problems that deserved specific attention at all centres. A change in prescription practices may reduce unnecessary drug use and decrease antimicrobial resistance.
Longitudinal surveillance of antibiotic use in the hospital
QJM, 2001
We evaluated antimicrobial use in our hospital by department, including indications for use, source of infections, use of the microbiology laboratory, and appropriateness of prescribing, in a prospective, comparative, non-interventional study of all patients receiving antimicrobial agents. We excluded departments where antimicrobial use was negligible. The other 19 departments were followed for 3 (n = 4) or 4 (n=15) months, including 2 consecutive months in the spring-summer and either 1 or 2 in the autumn-winter. Antimicrobial therapy was followed from initiation, through possible adaptations, and possible change from intravenous to oral therapy, until discontinuation of treatment. Overall, 6376 antibiotics were given to 2306 patients. Of the surveyed hospitalized patients, 62%"22% received antibiotics, with a range of 4±100% per department. Antibiotics were prescribed for infections acquired in the community (3037 instances, 47%), in the hospital (2182, 34%), in a nursing home (575, 9%), and for prophylaxis continued post-operatively (582, 9%). The most common indications for antimicrobial use were: respiratory tract infection (1729, 27%), urinary tract infection (955, 15%), sepsis (701, 11%), intra-abdominal infections (663, 10%), prophylaxis 582 (9%), soft-tissue infection (572, 9%), and surgical site infection (319, 5%). Univariate indicators for appropriateness of treatment were: age, department, site of infection, source of infection, antimicrobial drug and serum creatinine (all p-0.001). Forty-nine antimicrobials were prescribed in 279 combinations, 58% as single agent and 42% as drug combinations. Half of all antimicrobial use consisted of four agents: cefuroxime (19.1%), metronidazole (11.3%), gentamicin (10.6%) and ampicillin (10.2%), which together accounted for 20% of expenditure on antibiotics. Although use of as many as 53% of antimicrobials (26/49) surveyed was restricted, use in this category accounted for only 29% of all antimicrobial courses. Of 6376 antibiotic courses, 4101 (64%) were given intravenously and 2275 (36%) orally. Appropriateness of use of restricted drugs was lower (70%) than of unrestricted ones (84%, p-0.001). Of 24 571 defined daily doses (DDD) given orally, 4587 (19%) were restricted, compared to 7264 (34%) of 21 602 DDDs given intravenously (p-0.001). Antibiotic treatment in our hospital appears to be substantial and increasing, justifying efforts to improve appropriateness of therapy and improve clinical and financial results.
A national evaluation of antibiotic expenditures by healthcare setting in the United States, 2009
Journal of Antimicrobial Chemotherapy, 2013
Objectives: Promoting appropriate antibiotic use has the potential to decrease healthcare costs by reducing unnecessary prescriptions and the incidence of resistant infections. However, little is known about where antibiotic costs are incurred in the US healthcare system. We evaluated antibiotic expenditures by healthcare setting and antibiotic class in the USA.
Pattern of Antibiotic Use among Hospitalized Patients at a Level One Multidisciplinary Care Hospital
Healthcare
Background: Antimicrobial resistance is one of the world’s most serious health issues. Antibiotic resistance, excessive drug expense, and an increased risk of adverse reactions are all common outcomes of incorrect antibiotic prescribing. The goal of this study was to evaluate the prevalence of antibiotic prescriptions for inpatients to find areas for improvement. Methods: A retrospective study at Emergency Clinical County Hospital of Oradea, Romania was performed for five years between 2017 and 2021. Data was collected using medical records of the patients and reports from the pharmacy. Antibiotic consumption was expressed as DDD/100 BD according to the World Health Organization (WHO) by antibiotics, classes, and AWaRe classification. Results: The prevalence of antibiotic prescription was 53.8% during five years evaluated with a significant increase in 2021. A total of 13,677.42 DDD/100 BD antibiotics were prescribed, especially for surgical and medical prophylaxes. The most prescri...
2019
Introduction Antibiotics are among the most commonly misused of all drugs,which results in antibiotic resistance and waste of resources and it has not been studied in Ethiopia. Therefore, this study was carried out to assess antibiotic use–related problems and their costs among patients hospitalized at the surgical ward of Jimma University Medical Center. Methods A hospital-based prospective observational study was used to assess the prevalence, cost, and determinants of antibiotic use related problems; multiple stepwise backward logistic regression analysis was done for a P value of<0.25 to look for predictors of antibiotic use-related problems. Written informed consent was obtained and confidentiality was secured. Results Among 300 participants, antibiotic-use related problems(ABURPs)were found in 69.3%of the study participants. The direct total cost attributed to these problems was approximated to a minimum of 2230.15US$. Independent predictors for antibiotic use–related problems were: indication forantibioticuselike: use of antibiotic for prophylaxis; p< 0.0001, antibiotic-use for both therapeutic &prophylaxis; p<0.0001, CDC wound class I and II; p=0.016 and; p=0.002 respectively, overall poly-pharmacy and greater than 2 antibiotic exposure during hospital stay; p=0.019 and p=0.006 respectively and hospital stay for> 21days; p=0.007. Conclusion The prevalence of antibiotic use-related problems was high and resulted in extra cost. Antibiotic use for prophylaxis, prophylaxis, and treatment, poly-pharmacy, greater than 2 antibiotic exposures during the hospital stay, CDC wound class I and II, and duration of hospital stay of >= 21 days was found to be independent predictors of antibiotic use-related problems.
Antimicrobial Resistance & Infection Control
Objectives Antimicrobial Stewardship Programs commonly have an in-hospital focus. Little is known about the quality of antimicrobial use in hospital outpatient clinics. We investigated the extent and appropriateness of antimicrobial prescriptions in the outpatient clinics of three hospitals. Methods From June 2018 to January 2019, we performed ten point prevalence surveys in outpatient clinics of one university hospital and two large teaching hospitals. All prophylactic and therapeutic prescriptions were retrieved from the electronic medical records. Appropriateness was defined as being in accordance with guidelines. Furthermore, we investigated the extent to which the dose was adjusted to renal function and documentation of an antibiotic plan in the case notes. Results We retrieved 720 prescriptions for antimicrobial drugs, of which 173 prescriptions (24%) were prophylactic. A guideline was present for 95% of prescriptions, of which the guideline non-adherence rate was 25.6% (n = 4...
A prospective assessment of antimicrobial agents utilization pattern in a tertiary care hospital
International Journal of Basic & Clinical Pharmacology, 2016
Background: The antimicrobial resistance is increasing globally and, concurrently, downward trend in development of newer antibiotics is leading to a serious public health problem and economic consequences.Methods: Prescriptions with at least one antimicrobial were included in the study. A total of 242 prescriptions were included in the study. The antimicrobials were classified into different classes based on WHO-ATC classification.Results: A total of 281 antimicrobials prescribed in 242 prescriptions with an average of 1.16 per prescription. In most of the prescriptions, 1 antimicrobial were prescribed (88.43%). The routes of the antimicrobial administration were mostly oral 268 (95.37%) followed by injectable 13 (4.63%). The most commonly prescribed classes of antimicrobial in this study were antibacterials for systemic use (J01) (74.02%) followed by antimycobacterials (J04) (13.88%), antiparasitic drugs (P) (8.19%), antimycotics for systemic use (J02) (2.49%) and antivirals for s...