Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-19T23:35:14.325Z Has data issue: false hasContentIssue false
  • English
  • Français

Indications and Types of Antibiotic Agents Used in 6 Acute Care Hospitals, 2009–2010: A Pragmatic Retrospective Observational Study

Published online by Cambridge University Press:  12 October 2015

Theodoros Kelesidis ,
Nikolay Braykov ,
Daniel Z. Uslan ,
Daniel J. Morgan ,
Sumanth Gandra ,
Birgir Johannsson ,
Marin L. Schweizer ,
Scott A. Weisenberg ,
Heather Young  and
Joseph Cantey
...Show all authors
Theodoros Kelesidis
Affiliation:
Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
Nikolay Braykov
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC
Daniel Z. Uslan
Affiliation:
Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
Daniel J. Morgan
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC Department of Epidemiology and Public Health, University of Maryland School of Medicine and Veterans Administration Maryland Healthcare System, Baltimore, Maryland
Sumanth Gandra
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC
Birgir Johannsson
Affiliation:
Iowa City Veterans Administration Health Care System, Iowa City, Iowa
Marin L. Schweizer
Affiliation:
Iowa City Veterans Administration Health Care System, Iowa City, Iowa
Scott A. Weisenberg
Affiliation:
Alta Bates Summit Medical Center, Oakland, California
Heather Young
Affiliation:
Denver Health Medical Center, Denver, Colorado
Joseph Cantey
Affiliation:
Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
Eli Perencevich
Affiliation:
Iowa City Veterans Administration Health Care System, Iowa City, Iowa
Edward Septimus
Affiliation:
Texas A&M Health Science Center College of Medicine, Houston, Texas Clinical Services Group, HCA Inc, Nashville, Tennessee
Arjun Srinivasan
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Ramanan Laxminarayan*
Affiliation:
Center for Disease Dynamics, Economics & Policy, Washington, DC Princeton Environmental Institute, Princeton University, Princeton, New Jersey Public Health Foundation of India, New Delhi, India
*
Address correspondence to Ramanan Laxminarayan, PhD, MPH, Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW Ste 500, Washington, DC 20005 (ramanan@cddep.org).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

To design better antimicrobial stewardship programs, detailed data on the primary drivers and patterns of antibiotic use are needed.

OBJECTIVE

To characterize the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial stewardship programs.

DESIGN, PARTICIPANTS, AND SETTING

Retrospective medical chart review was performed on a random cross-sectional sample of 1,200 adult inpatients, hospitalized (>24 hrs) in 6 hospitals, and receiving at least 1 antibiotic dose on 4 index dates chosen at equal intervals through a 1-year study period (October 1, 2009–September 30, 2010).

METHODS

Infectious disease specialists recorded patient demographic characteristics, comorbidities, microbiological and radiological testing, and agents used, dose, duration, and indication for antibiotic prescriptions.

RESULTS

On the index dates 4,119 (60.5%) of 6,812 inpatients were receiving antibiotics. The random sample of 1,200 case patients was receiving 2,527 antibiotics (average: 2.1 per patient); 540 (21.4%) were prophylactic and 1,987 (78.6%) were therapeutic, of which 372 (18.7%) were pathogen-directed at start. Of the 1,615 empirical starts, 382 (23.7%) were subsequently pathogen-directed and 1,231 (76.2%) remained empirical. Use was primarily for respiratory (27.6% of prescriptions) followed by gastrointestinal (13.1%) infections. Fluoroquinolones, vancomycin, and antipseudomonal penicillins together accounted for 47.1% of therapy-days.

CONCLUSIONS

Use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities and in most instances was not subsequently pathogen directed. Fluoroquinolones, vancomycin, and antipseudomonal penicillins were the most frequently used antibiotics, particularly for respiratory indications.

Infect. Control Hosp. Epidemiol. 2015;37(1):70–79

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Supplement 1 , January 2016 , pp. 70 - 79
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. World Health Organization (WHO). WHO’s first global report on antibiotic resistance reveals serious, worldwide threat to public health. WHO website. http://www.who.int/mediacentre/news/releases/2014/amr-report/en/. Published April 30, 2014. Accessed November 5, 2014.Google Scholar
2. Dellit, TH, Owens, RC, McGowan, JE Jr, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.CrossRefGoogle Scholar
3. Lipsky, BA, Moran, GJ, Napolitano, LM, Vo, L, Nicholson, S, Kim, M. A prospective, multicenter, observational study of complicated skin and soft tissue infections in hospitalized patients: clinical characteristics, medical treatment, and outcomes. BMC Infect Dis 2012;12:227.CrossRefGoogle ScholarPubMed
4. Johannsson, B, Beekmann, SE, Srinivasan, A, Hersh, AL, Laxminarayan, R, Polgreen, PM. Improving antimicrobial stewardship: the evolution of programmatic strategies and barriers. Infect Control Hosp Epidemiol 2011;32:367–374.Google Scholar
5. Abbo, L, Lo, K, Sinkowitz-Cochran, R, et al. Antimicrobial stewardship programs in Florida’s acute care facilities. Infect Control Hosp Epidemiol 2013;34:634–637.Google Scholar
6. Ansari, F, Erntell, M, Goossens, H, Davey, P. The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis 2009;49:1496–1504.Google Scholar
7. MacDougall, C, Polk, RE. Variability in rates of use of antibacterials among 130 US hospitals and risk-adjustment models for interhospital comparison. Infect Control Hosp Epidemiol 2008;29:203–211.Google Scholar
8. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
9. Polk, RE, Hohmann, SF, Medvedev, S, Ibrahim, O. Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infect Dis 2011;53:1100–1110.CrossRefGoogle ScholarPubMed
10. Magill, SS, Edwards, JR, Beldavs, ZG, et al. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA 2014;312:1438–1446.Google Scholar
11. Malacarne, P, Rossi, C, Bertolini, G. Antibiotic usage in intensive care units: a pharmaco-epidemiological multicentre study. J Antimicrob Chemother 2004;54:221–224.Google Scholar
12. Mettler, J, Simcock, M, Sendi, P, et al. Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study. BMC Infect Dis 2007;7:21.CrossRefGoogle Scholar
13. Montravers, P, Dupont, H, Gauzit, R, Veber, B, Bedos, JP, Lepape, A. Strategies of initiation and streamlining of antibiotic therapy in 41 French intensive care units. Crit Care 2011;15:R17.Google Scholar
14. Warren, MM, Gibb, AP, Walsh, TS. Antibiotic prescription practice in an intensive care unit using twice-weekly collection of screening specimens: a prospective audit in a large UK teaching hospital. J Hosp Infect 2005;59:90–95.Google Scholar
15. Cusini, A, Rampini, SK, Bansal, V, et al. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey. PLoS One 2010;5:e14011.CrossRefGoogle Scholar
16. Glowacki, RC, Schwartz, DN, Itokazu, GS, Wisniewski, MF, Kieszkowski, P, Weinstein, RA. Antibiotic combinations with redundant antimicrobial spectra: clinical epidemiology and pilot intervention of computer-assisted surveillance. Clin Infect Dis 2003;37:59–64.Google Scholar
17. Hecker, MT, Aron, DC, Patel, NP, Lehmann, MK, Donskey, CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972–978.Google Scholar
18. Kollef, MH, Morrow, LE, Niederman, MS, et al. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest 2006;129:1210–1218.CrossRefGoogle ScholarPubMed
19. Robert, J, Pean, Y, Varon, E, et al. Point prevalence survey of antibiotic use in French hospitals in 2009. J Antimicrob Chemother 2012;67:1020–1026.CrossRefGoogle ScholarPubMed
20. Chun, ED, Rodgers, PE, Vitale, CA, Collins, CD, Malani, PN. Antimicrobial use among patients receiving palliative care consultation. Am J Hosp Palliat Care 2010;27:261–265.Google Scholar
21. Gerber, JS, Newland, JG, Coffin, SE, et al. Variability in antibiotic use at children’s hospitals. Pediatrics 2010;126:1067–1073.Google Scholar
22. Huttner, B, Jones, M, Huttner, A, Rubin, M, Samore, MH. Antibiotic prescription practices for pneumonia, skin and soft tissue infections and urinary tract infections throughout the US Veterans Affairs system. J Antimicrob Chemother 2013;68:2393–2399.Google Scholar
23. Zilberberg, MD, Shorr, AF, Micek, ST, Mody, SH, Kollef, MH. Antimicrobial therapy escalation and hospital mortality among patients with health-care-associated pneumonia: a single-center experience. Chest 2008;134:963–968.Google Scholar
24. Fridkin, S, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep 2014;63:194–200.Google Scholar
25. Braykov, NP, Morgan, DJ, Schweizer, ML, et al. Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study. Lancet Infect Dis 2014;14:1220–1227.Google Scholar
26. Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.Google Scholar
27. Charlson, ME, Sax, FL. The therapeutic efficacy of critical care units from two perspectives: a traditional cohort approach vs a new case-control methodology. J Chronic Dis 1987;40:31–39.Google Scholar
28. Fernandez, R, Baigorri, F, Navarro, G, Artigas, A. A modified McCabe score for stratification of patients after intensive care unit discharge: the Sabadell score. Crit Care 2006;10:R179.Google Scholar
29. Madaras-Kelly, K. Optimizing antibiotic use in hospitals: the role of population-based antibiotic surveillance in limiting antibiotic resistance. Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2003;23:1627–1633.Google Scholar
30. Polk, RE, Fox, C, Mahoney, A, Letcavage, J, MacDougall, C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007;44:664–670.Google Scholar
31. Dalton, B, Sabuda, D, Conly, J. Trends in antimicrobial consumption may be affected by units of measure. Clin Infect Dis 2007;45:399–400.Google Scholar
32. Weiss, AJ, Elixhauser, A. Characteristics of adverse drug events originating during the hospital stay, 2011: statistical brief #164. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs . Rockville (MD): Agency for Health Care Policy and Research, 2006.Google Scholar
33. Davey, P, Brown, E, Charani, E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013;4:CD003543.Google Scholar
34. Ohl, CA, Luther, VP. Antimicrobial stewardship for inpatient facilities. J Hosp Med 2011;6:S4–15.CrossRefGoogle ScholarPubMed
35. Srinivasan, A, Fishman, N. Antimicrobial stewardship 2012: science driving practice. Infect Control Hosp Epidemiol 2012;33:319–321.Google Scholar
36. Schuetz, P, Briel, M, Christ-Crain, M, et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin Infect Dis 2012;55:651–662.Google Scholar
37. Schuetz, P, Briel, M, Mueller, B. Clinical outcomes associated with procalcitonin algorithms to guide antibiotic therapy in respiratory tract infections. JAMA 2013;309:717–718.CrossRefGoogle ScholarPubMed
38. Huang, AM, Newton, D, Kunapuli, A, et al. Impact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis 2013;57:1237–1245.Google Scholar
39. Paterson, DL. “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 2004;38:S341–S345.Google Scholar
40. O’Malley, KJ, Cook, KF, Price, MD, Wildes, KR, Hurdle, JF, Ashton, CM. Measuring diagnoses: ICD code accuracy. Health Serv Res 2005;40:1620–1639.Google Scholar
Supplementary material: File

Kelesidis supplementary material

Figure 1 and Table 1-2

Download Kelesidis supplementary material(File)
File 84.5 KB