title: Prevalence of antimicrobial use in US acute care hospitals, May-September 2011.
abstract: OBJECTIVE
  Inappropriate antimicrobial drug use is associated with adverse events in hospitalized patients and contributes to the emergence and spread of resistant pathogens. Targeting effective interventions to improve antimicrobial use in the acute care setting requires understanding hospital prescribing practices.
  
  
  OBJECTIVE
  To determine the prevalence of and describe the rationale for antimicrobial use in participating hospitals.
  
  
  METHODS
  One-day prevalence surveys were conducted in acute care hospitals in 10 states between May and September 2011. Patients were randomly selected from each hospital's morning census on the survey date. Data collectors reviewed medical records retrospectively to gather data on antimicrobial drugs administered to patients on the survey date and the day prior to the survey date, including reasons for administration, infection sites treated, and whether treated infections began in community or health care settings.
  
  
  METHODS
  Antimicrobial use prevalence, defined as the number of patients receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed patients.
  
  
  RESULTS
  Of 11,282 patients in 183 hospitals, 5635 (49.9%; 95% CI, 49.0%-50.9%) were administered at least 1 antimicrobial drug; 77.5% (95% CI, 76.6%-78.3%) of antimicrobial drugs were used to treat infections, most commonly involving the lower respiratory tract, urinary tract, or skin and soft tissues, whereas 12.2% (95% CI, 11.5%-12.8%) were given for surgical and 5.9% (95% CI, 5.5%-6.4%) for medical prophylaxis. Of 7641 drugs to treat infections, the most common were parenteral vancomycin (1103, 14.4%; 95% CI, 13.7%-15.2%), ceftriaxone (825, 10.8%; 95% CI, 10.1%-11.5%), piperacillin-tazobactam (788, 10.3%; 95% CI, 9.6%-11.0%), and levofloxacin (694, 9.1%; 95% CI, 8.5%-9.7%). Most drugs administered to treat infections were given for community-onset infections (69.0%; 95% CI, 68.0%-70.1%) and to patients outside critical care units (81.6%; 95% CI, 80.4%-82.7%). The 4 most common treatment antimicrobial drugs overall were also the most common drugs used for both community-onset and health care facility-onset infections and for infections in patients in critical care and noncritical care locations.
  
  
  CONCLUSIONS
  In this cross-sectional evaluation of antimicrobial use in US hospitals, use of broad-spectrum antimicrobial drugs such as piperacillin-tazobactam and drugs such as vancomycin for resistant pathogens was common, including for treatment of community-onset infections and among patients outside critical care units. Further work is needed to understand the settings and indications for which reducing antimicrobial use can be most effectively and safely accomplished.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Shelley S
authors.initials: SS
authors.lastname: Magill
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Edwards
authors.affiliation: Oregon Public Health Division, Oregon Health Authority, Portland.
authors.forename: Zintars G
authors.initials: ZG
authors.lastname: Beldavs
authors.affiliation: New York-Rochester Emerging Infections Program and University of Rochester Medical Center, Rochester.
authors.forename: Ghinwa
authors.initials: G
authors.lastname: Dumyati
authors.affiliation: Colorado Department of Public Health and Environment, Denver.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Janelle
authors.affiliation: Tennessee Department of Health, Nashville.
authors.forename: Marion A
authors.initials: MA
authors.lastname: Kainer
authors.affiliation: Minnesota Department of Health, St Paul.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.affiliation: California Emerging Infections Program, Oakland.
authors.forename: Joelle
authors.initials: J
authors.lastname: Nadle
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia8Department of Veterans Affairs Pharmacy Benefits Management Services, Hines, Illinois.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Neuhauser
authors.affiliation: Georgia Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Decatur10Georgia Emerging Infections Program, Emory University School of Medicine, Atlanta.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ray
authors.affiliation: Maryland Department of Health and Mental Hygiene, Baltimore.
authors.forename: Katherine
authors.initials: K
authors.lastname: Richards
authors.affiliation: Connecticut Department of Public Health, Hartford.
authors.forename: Richard
authors.initials: R
authors.lastname: Rodriguez
authors.affiliation: New Mexico Department of Health, Santa Fe.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Thompson
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Fridkin
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy; D003430:Cross-Sectional Studies; D003625:Data Collection; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000188:drug therapy; D007297:Inpatients / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D000890:Anti-Infective Agents