title: Economic impact of redundant antimicrobial therapy in US hospitals.
abstract: BACKGROUND
  Overutilization of antimicrobial therapy places patients at risk for harm and contributes to antimicrobial resistance and escalating healthcare costs. Focusing on redundant or duplicate antimicrobial therapy is 1 recommended strategy to reduce overutilization and its attendant effects on patient safety and hospital costs.
  
  
  OBJECTIVE
  This study explored the incidence and economic impact of potentially redundant antimicrobial therapy.
  
  
  METHODS
  We conducted a retrospective analysis of inpatient administrative data drawn from 505 nonfederal US hospitals. All hospitalized patients discharged between January 1, 2008, and December 31, 2011, were eligible for study inclusion. Potentially redundant antimicrobial therapy was identified from pharmacy records and was defined as patients receiving treatment with overlapping antibiotic spectra for 2 or more consecutive days.
  
  
  RESULTS
  We found evidence of potentially inappropriate, redundant antimicrobial coverage for 23 different antimicrobial combinations in 394 of the 505 (78%) hospitals, representing a total of 32,507 cases. High-frequency redundancies were observed in 3 antianaerobic regimens, accounting for 22,701 (70%) of the cases. Of these, metronidazole and piperacillin-tazobactam accounted for 53% (n = 17,326) of all potentially redundant cases. Days of redundant therapy totaled 148,589, representing greater than $12 million in potentially avoidable healthcare costs.
  
  
  CONCLUSIONS
  Our study suggests that there may be pervasive use of redundant antimicrobial therapy within US hospitals. Appropriate use of antimicrobials may reduce the risk of harm to patients and lower healthcare costs.
authors.affiliation: Premier Safety Institute, Premier, Charlotte, North Carolina.
authors.forename: Leslie
authors.initials: L
authors.lastname: Schultz
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Lowe
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Dwight
authors.initials: D
authors.lastname: Neilson
authors.forename: Gina
authors.initials: G
authors.lastname: Pugliese
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000191:economics* / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000188:drug therapy / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data; D004469:Economics, Hospital / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics* / Q000706:statistics & numerical data; D055624:Methicillin-Resistant Staphylococcus aureus; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000191:economics; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents