title: Initiation and termination of antibiotic regimens in Veterans Affairs hospitals.
abstract: OBJECTIVE
  To assess rates of starting or stopping antibiotics across different hospitals.
  
  
  METHODS
  We used barcode medication administration data to measure antibiotic use on acute-care wards in 128 Veterans Affairs medical centres (VAMCs) in 2010. A treatment day (TD) was defined as the administration of any antibiotic on a given day. A treatment period (TP) was defined as an interval of inpatient antimicrobial therapy with gaps of ≤1 day in TDs. The rate of starting antibiotics was calculated for inpatients who had not yet started antibiotics, as the number of start events divided by the 'person-time at risk'. The rate of stopping antibiotics was calculated analogously for inpatients that were on antibiotics. Once individuals had stopped antibiotics they were removed from further analysis. Per-day start and stop rates were also calculated for each day of hospitalization.
  
  
  RESULTS
  The hospital mean rate of starting the first TP was 18.1 start events/100 days at risk (range 8.4-25.6/100 days at risk). The mean hospital stopping rate was 21.1 stop events/100 days at risk (range 13.3-29.5/100 days at risk). The ratio of a facility's starting and stopping rates was highly correlated with overall antibiotic use in TDs/1000 patient-days (rs=0.92, P<0.001), while starting and stopping rates individually were only moderately correlated (rs=0.39, P<0.001).
  
  
  CONCLUSIONS
  VAMCs with similar antibiotic use showed marked differences in their starting and stopping rates of antibiotics. It may be useful to target empirical therapy when starting rates are high and definitive therapy when stopping rates are low.
authors.affiliation: VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Huttner
authors.affiliation: VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA makoto.jones@va.gov.
authors.forename: Makoto
authors.initials: M
authors.lastname: Jones
authors.affiliation: Boise VA Medical Center, Boise, ID 83702, USA College of Pharmacy, Idaho State University, Meridian, ID 83713, USA.
authors.forename: Karl
authors.initials: K
authors.lastname: Madaras-Kelly
authors.affiliation: Department of Veterans Affairs Pharmacy Benefit Management Services, Hines, IL, USA.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Neuhauser
authors.affiliation: VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rubin
authors.affiliation: VA Greater LA Healthcare System, Los Angeles, CA 90073, USA David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA.
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.affiliation: VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006782:Hospitals, Special; D006801:Humans; D007239:Infections / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D014728:Veterans
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic use; infectious diseases; practice variation