title: Antimicrobial therapy in obesity: a multicentre cross-sectional study.
abstract: OBJECTIVE
  Evidence indicates a relationship between obesity and infection. We assessed the prevalence of obesity in hospitalized patients and evaluated its impact on antimicrobial management.
  
  
  METHODS
  Three National Health Service hospitals in London in 2011-12 were included in a cross-sectional study. Data from all adult admissions units and medical and surgical wards were collected. Patient data were collected from the medication charts and nursing and medical notes. Antimicrobial therapy was defined as 'complicated' if the patient's therapy met two or more of the following criteria: (i) second- or third-line therapy according to local policy; (ii) intravenous therapy where an alternative oral therapy was appropriate; (iii) longer than the recommended duration of therapy as per local policy recommendations; (iv) repeated courses of therapy to treat the same infection; and (v) specialist advice on antimicrobial therapy provided by the medical microbiology or infectious diseases teams.
  
  
  RESULTS
  Of the 1014 patients included in this study, 22% (225) were obese, 69% (696) were normal/overweight and 9% (93) were underweight. Obese patients were significantly more likely to have more complicated antimicrobial therapy than normal/overweight and underweight patients (36% versus 19% and 23%, respectively, P = 0.002). After adjustment for hospital, age group, comorbidities and the type of infection, obese patients remained at significantly increased odds of receiving complicated antimicrobial therapy compared with normal/overweight patients (OR = 2.01, 95% CI 1.75-3.45).
  
  
  CONCLUSIONS
  One in five hospitalized patients is obese. Compared with the underweight and normal/overweight, the antimicrobial management in the obese is significantly more complicated.
authors.affiliation: National Institute of Health Research Health Protection Research Unit, Imperial College London, Hammersmith Campus, London W12 ONN, UK e.charani@imperial.ac.uk.
authors.forename: Esmita
authors.initials: E
authors.lastname: Charani
authors.affiliation: National Institute of Health Research Health Protection Research Unit, Imperial College London, Hammersmith Campus, London W12 ONN, UK.
authors.forename: Myriam
authors.initials: M
authors.lastname: Gharbi
authors.affiliation: Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, UK.
authors.forename: Gary
authors.initials: G
authors.lastname: Frost
authors.affiliation: National Institute of Health Research Health Protection Research Unit, Imperial College London, Hammersmith Campus, London W12 ONN, UK Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: Lydia
authors.initials: L
authors.lastname: Drumright
authors.affiliation: National Institute of Health Research Health Protection Research Unit, Imperial College London, Hammersmith Campus, London W12 ONN, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Holmes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D003428:Cross Infection; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D007239:Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology*; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology*; D015995:Prevalence; D062486:Public Health Surveillance
chemical_list: D000890:Anti-Infective Agents