Estimating National Trends in Inpatient Antibiotic Use Among US Hospitals From 2006 to 2012 (original) (raw)
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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...
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.
Benchmarking Risk-Adjusted Adult Antibacterial Drug Use in 70 US Academic Medical Center Hospitals
Clinical Infectious Diseases, 2011
Background. Antimicrobial stewardship programs are advised to measure and risk-adjust antimicrobial use to facilitate interhospital comparisons, a process called benchmarking. The purpose of this investigation was to evaluate a new benchmarking strategy for antibacterials. Methods. Hospital-wide adult antibacterial drug use in 2009 was measured as days of therapy (DOT) and length of therapy (LOT) from billing records in 70 US academic medical centers (AMCs). Patients were assigned to 1 of 35 clinical service lines (CSL) based on their Medicare Severity Diagnosis Related Group. Expected (E) use was determined by indirect standardization and compared with observed (O) use. Results. Of 1 791 180 discharged adults, 63.7% received antibacterial drugs; the range by CSL was 14.3% (psychiatry) to 99.7% (lung transplant). Mean 6 SD hospital-wide use was 839 6 106 DOTs (range, 594-1109) and 536 6 53.0 LOT (range, 427-684) per 1000 patient-days. The ventilator support CSL had the most DOT per discharge, 39.4 6 9.4 days; the LOT was 21.5 6 4.5 days. The hospital-wide O/E ratio range was 0.7-1.45; in 5 AMCs the ratio exceeded the 90% confidence interval (CI) and was below the 90% CI in 6. Variability in use was explained by the proportion of treated patients within each CSL and mean LOT and DOT per discharge. Conclusions. Adult antibacterial drug use was benchmarked to expected use adjusted for patient mix, and outlier hospitals were identified. Differences between expected and observed use reflect usage patterns that were benchmarked and are targets for evaluation and intervention.
Variability in Antibiotic Use at Children's Hospitals
PEDIATRICS, 2010
Background-Variation in medical practice has identified opportunities for quality improvement in patient care. The degree of variation in the use of antibiotics in children's hospitals is unknown. Methods-We conducted a retrospective cohort study of 556,692 consecutive pediatric inpatient discharges from 40 freestanding children's hospitals between January 1, 2008 and December 31, 2008. We used the Pediatric Health Information System to acquire data on antibiotic use and clinical diagnoses. Results-Overall, 60% of children received at least one antibiotic agent during their hospitalization, including more than 90% of patients who had surgery, underwent central venous catheter placement, had prolonged ventilation, or remained in the hospital for greater than 14 days. Even after adjustment for both hospital-level and patient-level demographic and clinical characteristics, antibiotic use varied substantially across hospitals as both the proportion of children exposed to antibiotics (38 to 72%) and the number of days children received antibiotics (368 to 601 antibiotic days per 1000 patient days) ranged broadly. In general, hospitals using more antibiotics also used a higher proportion of broad-spectrum antibiotics. Conclusions-Children's hospitals vary substantially in their use of antibiotics, to a degree unexplained by patient or hospital-level factors typically associated with the need for antibiotic therapy, revealing an opportunity to improve the use of these drugs.
Validating hospital antibiotic purchasing data as a metric of inpatient antibiotic use
The Journal of antimicrobial chemotherapy, 2015
Antibiotic purchasing data are a widely used, but unsubstantiated, measure of antibiotic consumption. To validate this source, we compared purchasing data from hospitals and external medical databases with patient-level dispensing data. Antibiotic purchasing and dispensing data from internal hospital records and purchasing data from IMS Health were obtained for two hospitals between May 2013 and April 2015. Internal purchasing data were validated against dispensing data, and IMS data were compared with both internal metrics. Scatterplots of individual antimicrobial data points were generated; Pearson's correlation and linear regression coefficients were computed. A secondary analysis re-examined these correlations over shorter calendar periods. Internal purchasing data were strongly correlated with dispensing data, with correlation coefficients of 0.90 (95% CI = 0.83-0.95) and 0.98 (95% CI = 0.95-0.99) at hospitals A and B, respectively. Although dispensing data were consistentl...
Benchmarking Inpatient Antimicrobial Use: A Comparison of Risk-Adjusted Observed-to-Expected Ratios
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018
Increasing antibiotic resistance has made benchmarking appropriate inpatient antibiotic use a worldwide priority supported by expert societies and regulatory bodies, however standard risk-adjustment for fair inter-facility comparison has been elusive. We describe a risk-adjusted antibiotic exposure ratio that may help facilitate assessment of antimicrobial use. Retrospective cohort study of 2.7 million admissions evaluating a wide array of potential explanatory variables for correlation with expected antibiotic consumption in a two-step approach using recursive partitioning and Poisson regression. Observed-to-expected ratios of risk-adjusted antibiotic use were calculated. Three models of varying complexity were compared: (a) a Complex Ratio consisting of all available antibiotic use risk factors in a hierarchical model; (b) a Simplified ASP Ratio using common facility and encounter factors in a single level model; and (c) a Facility Ratio using only broad hospital characteristics. ...
Clinical Infectious Diseases, 2007
Background. Hospitals are advised to measure antibiotic use and monitor its relationship to resistance. The World Health Organization's recommended metric is the defined daily dose (DDD). An alternative measure is the number of days of therapy (DOT). The purpose of this study was to contrast these measures. Methods. We measured the use of 50 antibacterial drugs that were administered to adults who were discharged from 130 US hospitals during 1 August 2002-31 July 2003. Results. Of 1,795,504 patients, 1,074,174 received at least 1 dose of an antibacterial drug (59.8%). The mean ע( standard deviation) of total antibacterial drug use measured by the number of DDDs per 1000 patient-days and the number of DOTs per 1000 patient-days were not significantly different (and , re-792 ע 147 776 ע 120 spectively;), although the correlation was poor (). For some individual drugs, such as levofloxacin P p .137 r p 0.603 and linezolid, there was no significant difference between DDDs per 1000 patient-days and DOTs per 1000 patientdays, because the administered daily dosage was nearly equivalent to the DDD. When the administered dosage exceeded the DDD, such as for ampicillin-sulbactam and cefepime, estimates of use based on DDDs per 1000 patient-days significantly exceeded those based on DOTs per 1000 patient-days (). When the administered P ! .001 dosage was less than the DDD, such as for piperacillin-tazobactam and ceftriaxone, estimates of use based on DDDs per 1000 patient-days were significantly lower than those based on DOTs per 1000 patient-days (). P ! .001 Conclusion. The measurement of aggregate hospital antibiotic use by DDDs per 1000 patient-days and DOTs per 1000 patient-days is discordant for many frequently used antibacterial drugs, because the administered dose is dissimilar from the DDD recommended by the World Health Organization. DDD methods are useful for benchmarking purposes but cannot be used to make inferences about the number of DOTs or relative use for many antibacterial drugs.
Trends of Inpatient Antibiotic Consumption in a Children’s Clinic
Mediterranean Journal of Infection Microbes and Antimicrobials, 2021
Antimicrobials are the most commonly used medications among inpatient children. Moreover, a direct correlation exists between the magnitude of antibiotic consumption and the prevalence of resistant organisms. Surveying the trends of antibiotic consumption is crucial for establishing initiatives that are aimed at combating antibiotic-resistant infections by enhancing the rational use of antimicrobials. The objective of this study is to assess the trends of antibiotic consumption among hospitalized children for contributing toward future studies and establishing promising awareness-raising policies for appropriate antimicrobial use. Materials and Methods: The study was conducted retrospectively in a tertiary research hospital's pediatric ward of 50 beds. Using the hospital pharmacy and administrative databases between January 1, 2014, and December 31, 2019, all hospitalized children who received antimicrobials in that period were included. Data regarding antimicrobial use were evaluated according to anatomical therapeutic chemical/defined daily doses (ATC/ DDD) index methodology, described in "World Health Organisation Guidelines for ATC classification and DDD assignment 2020." Data of antibiotic consumptions were revealed with a unit as DDD/1,000 patient-days (PD). The time trends of antibiotic consumption were statistically analyzed by linear regression. Results: Data of 11,519 pediatric inpatients were recorded, in which 6,103 (53.0%) were boys and 5,416 patients (47.0%) were girls. The median age of the patients was two years. Ceftriaxone was the most commonly used antibiotic throughout the study period. Ceftriaxone utilization has increased by 19.5% between 2014 and 2019. Despite being the most commonly used carbapenem in the study, meropenem consumption decreased significantly from 2014 to 2019 (ATC/DDD index in 2014=46.22/1,000 PD; in 2019=11.62/1,000 PD) (p=0.008). Amikacin consumption was greater than gentamicin use by 2017, but vice versa from 2017 onward. The total antibiotic consumption peaked by 2016 (856.35/1,000 PD), amid a slight drop from 2014 to 2019 (p=0.667). Conclusion: Assessing regional antimicrobial consumptions periodically is critical for establishing current antibiotic stewardship initiatives that enable the rational use of antibiotics for combating bacterial resistance.