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

Theodoros Kelesidis; Nikolay Braykov; Daniel Z Uslan; Daniel J Morgan; Sumanth Gandra; Birgir Johannsson; Marin L Schweizer; Scott A Weisenberg; Heather Young; Joseph Cantey; Eli Perencevich; Edward Septimus; Arjun Srinivasan; Ramanan Laxminarayan

doi:10.1017/ice.2015.226

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

Journal article

Open access

Peer reviewed

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

Theodoros Kelesidis, Nikolay Braykov, Daniel Z Uslan, Daniel J Morgan, Sumanth Gandra, Birgir Johannsson, Marin L Schweizer, Scott A Weisenberg, Heather Young, Joseph Cantey, …

Infection control and hospital epidemiology, Vol.37(1), pp.70-79

01/2016

DOI: 10.1017/ice.2015.226

PMCID: PMC7011437

PMID: 26456803

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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.

Escherichia coli Infections - drug therapy

Staphylococcal Infections - drug therapy

Antibiotic Prophylaxis - statistics & numerical data

Cross-Sectional Studies

Penicillins - therapeutic use

Pseudomonas Infections - drug therapy

Humans

Middle Aged

Fluoroquinolones - therapeutic use

Respiratory Tract Infections - drug therapy

Random Allocation

Gastrointestinal Diseases - microbiology

Anti-Bacterial Agents - therapeutic use

Hospitals - statistics & numerical data

Vancomycin - therapeutic use

Gastrointestinal Diseases - drug therapy

Adult

Aged

Retrospective Studies

Details

Title: Subtitle: Indications and Types of Antibiotic Agents Used in 6 Acute Care Hospitals, 2009-2010: A Pragmatic Retrospective Observational Study
Creators: Theodoros Kelesidis - 1Infectious Diseases,David Geffen School of Medicine/University of California,Los Angeles,Los Angeles,California
Nikolay Braykov - 2Center for Disease Dynamics,Economics & Policy,Washington,DC
Daniel Z Uslan - 1Infectious Diseases,David Geffen School of Medicine/University of California,Los Angeles,Los Angeles,California
Daniel J Morgan - 2Center for Disease Dynamics,Economics & Policy,Washington,DC
Sumanth Gandra - 2Center for Disease Dynamics,Economics & Policy,Washington,DC
Birgir Johannsson - 4Iowa City Veterans Administration Health Care System,Iowa City,Iowa
Marin L Schweizer - 4Iowa City Veterans Administration Health Care System,Iowa City,Iowa
Scott A Weisenberg - 5Alta Bates Summit Medical Center,Oakland,California
Heather Young - 6Denver Health Medical Center,Denver,Colorado
Joseph Cantey - 7Department of Pediatrics,University of Texas Southwestern,Dallas,Texas
Eli Perencevich - 4Iowa City Veterans Administration Health Care System,Iowa City,Iowa
Edward Septimus - 8Texas A&M Health Science Center College of Medicine,Houston,Texas
Arjun Srinivasan - 10Centers for Disease Control and Prevention,Atlanta,Georgia
Ramanan Laxminarayan - 2Center for Disease Dynamics,Economics & Policy,Washington,DC
Resource Type: Journal article
Publication Details: Infection control and hospital epidemiology, Vol.37(1), pp.70-79
DOI: 10.1017/ice.2015.226
PMID: 26456803
PMCID: PMC7011437
NLM abbreviation: Infect Control Hosp Epidemiol
ISSN: 0899-823X
eISSN: 1559-6834
Publisher: United States
Grant note: R01 HS021188 / AHRQ HHS GS-10F-0163P / PHS HHS 2 UL1 TR000442-06 / NCATS NIH HHS UL1 TR000442 / NCATS NIH HHS
Language: English
Date published: 01/2016
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9983779296502771

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