title: Antimicrobial use in outpatient hemodialysis units.
abstract: OBJECTIVE
  To quantify and characterize overall antimicrobial use, including appropriateness of indication, among patients receiving chronic hemodialysis.
  
  
  METHODS
  Retrospective and prospective observational study.
  
  
  METHODS
  Two outpatient hemodialysis units.
  
  
  METHODS
  All patients receiving chronic hemodialysis.
  
  
  METHODS
  The rate of parenteral antimicrobial use (number of doses per 100 patient-months) was calculated retrospectively from September 2008 through July 2011. Indication and appropriateness of antimicrobial doses were characterized prospectively from August 2010 through July 2011. Inappropriate administration was defined as occasions when criteria for infection based on national guidelines were not met, failure to choose a more narrow-spectrum antimicrobial on the basis of culture data, or occasions when indications for surgical prophylaxis were not met.
  
  
  RESULTS
  Over the 35-month retrospective study period, the rate of parenteral antimicrobial use was 32.9 doses per 100 patient-months. Vancomycin was the most commonly prescribed antimicrobial, followed by cefazolin and third- or fourth-generation cephalosporins. Over the 12-month prospective study, 1,003 antimicrobial doses were prescribed. Among the 926 (92.3%) doses for which an indication for administration was available, 276 (29.8%) were classified as inappropriate. Of these, a total of 146 (52.9%) did not meet criteria for infection, 74 (26.8%) represented failure to choose a more narrow-spectrum antimicrobial, and 56 (20.3%) did not meet criteria for surgical prophylaxis. The most common inappropriately prescribed antimicrobials were vancomycin and third- or fourth- generation cephalosporins.
  
  
  CONCLUSIONS
  Parenteral antimicrobial use was extensive, and as much as one-third was categorized as inappropriate. The findings of this study provide novel information toward minimizing inappropriate antimicrobial use.
authors: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. gsnyder@bidmc.harvard.edu
authors: Graham M
authors: GM
authors: Snyder
authors: Priti R
authors: PR
authors: Patel
authors: Alexander J
authors: AJ
authors: Kallen
authors: James A
authors: JA
authors: Strom
authors: J Kevin
authors: JK
authors: Tucker
authors: Erika M C
authors: EM
authors: D'Agata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001900:Boston; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D011446:Prospective Studies; D012044:Regression Analysis; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents