Antibiotic use and cost indicators at a rural hospital: a pilot project.
BACKGROUND
Recently, simple antibiotic use and cost indicators were developed for use in long-term care facilities. It was hypothesized that these indicators also may be applicable to the acute hospital setting.


METHODS
For a 24-month period, data were collected quarterly on antibiotic use and cost indicators for 11 primary care physicians in a 40-bed rural hospital. Indicators included antimicrobial use ratio (AUR, ratio of the number of antibiotic days to the number of patient care days), cost per antibiotic day, and cost of antibiotics per patient care day. One-way analysis of variance and simple linear regression were used to analyze data.


RESULTS
Quinolones (oral plus parenteral) accounted for 26% of the total antibiotic days (N = 6020) followed by ceftriaxone (19%) and cefuroxime (11.8%; oral plus parenteral). Overall trends in antibiotic use and cost included a significant increase in quarterly AUR (R(2) = 0.78, P =.004) and cost per patient care day (R(2) = 0. 82, P =.002) but no significant change in quarterly total antibiotic costs or cost per antibiotic day. Among physicians there was a significant difference in mean quarterly AUR (P <.001) and mean quarterly cost per patient care day (P <.001) but no significant difference in mean quarterly cost per antibiotic day. Variation in physician-specific cost per patient care day was best explained by variation in AUR (R(2) = 0.75, P <.001).


CONCLUSIONS
Significant variation in simple antibiotic use and cost indicators was identified at a rural hospital from both the facility and physician perspective. Standardized methods for antibiotic use and cost monitoring, like the one described in this article, are required before the relationship between antibiotic use and resistance can be fully understood.
Mylotte
J M
JM
Departments of Medicine and Microbiology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA.
Weislo
P
P
D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use*; D016527:Drug Costs / Q000706:statistics & numerical data*; D017723:Drug Utilization Review / Q000191:economics* / Q000706:statistics & numerical data*; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data*; D006302:Health Services Research; D006743:Hospital Bed Capacity, under 100; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016014:Linear Models; D009518:New York; D010865:Pilot Projects; D011446:Prospective Studies
D000900:Anti-Bacterial Agents