title: The effect of renal dysfunction on antimicrobial use measurements.
abstract: The defined daily dose, a popular measurement of antimicrobial use, may underestimate the use of antimicrobials that are dose-adjusted in patients with renal insufficiency. To evaluate the effect of renal dysfunction on these measures, we performed a retrospective cohort study that involved patients receiving ceftriaxone, levofloxacin, or vancomycin, with use of defined daily doses and 2 methods based on therapy duration--stop-start days (i.e., entire therapy duration) and transaction days (i.e., unique therapeutic days). The vancomycin use rate for patients with renal insufficiency was 36% lower than that of patients with normal renal function for defined daily doses, and it was 23% lower for transaction days; for levofloxacin, there was a 27% rate reduction for the defined daily dose. No significant reduction was noted when the stop-start day method was used. Compared with the defined daily dose method, measures of therapy duration are less affected by renal function and may improve comparisons between populations.
authors.affiliation: University of Illinois at Chicago School of Public Health, Chicago, IL, USA. zagorski@email.com
authors.forename: B M
authors.initials: BM
authors.lastname: Zagorski
authors.forename: W E
authors.initials: WE
authors.lastname: Trick
authors.forename: D N
authors.initials: DN
authors.lastname: Schwartz
authors.forename: M F
authors.initials: MF
authors.lastname: Wisniewski
authors.forename: R C
authors.initials: RC
authors.lastname: Hershow
authors.forename: S K
authors.initials: SK
authors.lastname: Fridkin
authors.forename: R A
authors.initials: RA
authors.lastname: Weinstein
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D000075202:Contraindications; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000378:metabolism*
chemical_list: D000890:Anti-Infective Agents