Journal article
Antibiotic stewardship implementation and patient-level antibiotic use at hospitals with and without on-site Infectious Disease specialists
Clinical infectious diseases, Vol.72(10), pp.1810-1817
04/08/2020
DOI: 10.1093/cid/ciaa388
PMID: 32267496
Abstract
Many US hospitals lack Infectious Disease (ID) specialists, which may hinder antibiotic stewardship efforts. We sought to compare patient-level antibiotic exposure at Veterans Health Administration (VHA) hospitals with and without an on-site ID specialist, defined as an ID physician and/or ID pharmacist.
This retrospective VHA cohort included all acute-care patient-admissions during 2016. A mandatory survey was used to identify hospitals' antibiotic stewardship processes and their access to an on-site ID specialist. Antibiotic use was quantified as days of therapy (DOT) per days-present and categorized based on National Healthcare Safety Network definitions. A negative binomial regression model with risk adjustment was used to determine the association between presence of an on-site ID specialist and antibiotic use at the level of patient-admissions.
Eighteen of 122 (14.8%) hospitals lacked an on-site ID specialist; there were 525,451 (95.8%) admissions at ID hospitals and 23,007 (4.2%) at non-ID sites. In the adjusted analysis, presence of an ID specialist was associated with lower total inpatient antibacterial use [OR 0.92, (95% CI, 0.85-0.99)]. Presence of an ID specialist was also associated with lower use of broad-spectrum antibacterials [OR 0.61 (95% CI, 0.54-0.70)] and higher narrow-spectrum beta-lactam use [OR 1.43 (95% CI, 1.22-1.67)]. Total antibacterial exposure (inpatient plus post-discharge) was lower among patients at ID versus non-ID sites [OR 0.92 (95% CI, 0.86-0.99)].
Patients at hospitals with an ID specialist received antibiotics in a way more consistent with stewardship principles. The presence of an ID specialist may be important to effective antibiotic stewardship.
Details
- Title: Subtitle
- Antibiotic stewardship implementation and patient-level antibiotic use at hospitals with and without on-site Infectious Disease specialists
- Creators
- Daniel J Livorsi - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USARajeshwari Nair - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USABrian C Lund - Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USABruce Alexander - Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USABrice F Beck - Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USAMichihiko Goto - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USAMichael Ohl - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USAMary S Vaughan Sarrazin - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USAMatthew B Goetz - VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at the University of California in Los AngelesEli N Perencevich - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- Clinical infectious diseases, Vol.72(10), pp.1810-1817
- Publisher
- United States
- DOI
- 10.1093/cid/ciaa388
- PMID
- 32267496
- ISSN
- 1058-4838
- eISSN
- 1537-6591
- Grant note
- DOI: 10.13039/100007217, name: Health Services Research and Development, award: CDA 16–204
- Language
- English
- Date published
- 04/08/2020
- Academic Unit
- Pharmacy; Psychiatry; Infectious Diseases; Health Management and Policy; Epidemiology; Internal Medicine
- Record Identifier
- 9984001244002771
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