title: Trends in Antibiotic Use and Nosocomial Pathogens in Hospitalized Veterans With Pneumonia at 128 Medical Centers, 2006-2010.
abstract: BACKGROUND
  In 2005, pneumonia practice guidelines recommended broad-spectrum antibiotics for patients with risk factors for nosocomial pathogens. The impact of these recommendations on the ability of providers to match treatment with nosocomial pathogens is unknown.
  
  
  METHODS
  Among hospitalizations with a principal diagnosis of pneumonia at 128 Department of Veterans Affairs medical centers from 2006 through 2010, we measured annual trends in antibiotic selection; initial blood or respiratory cultures positive for methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Acinetobacter species; and alignment between antibiotic coverage and culture results for MRSA and P. aeruginosa, calculating sensitivity, specificity, and diagnostic odds ratio using a 2 × 2 contingency table.
  
  
  RESULTS
  In 95 511 hospitalizations for pneumonia, initial use of vancomycin increased from 16% in 2006 to 31% in 2010, and piperacillin-tazobactam increased from 16% to 27%, and there was a decrease in both ceftriaxone (from 39% to 33%) and azithromycin (change from 39% to 36%) (P < .001 for all). The proportion of hospitalizations with cultures positive for MRSA decreased (from 2.5% to 2.0%; P < .001); no change was seen for P. aeruginosa (1.9% to 2.0%; P = .14) or Acinetobacter spp. (0.2% to 0.2%; P = .17). For both MRSA and P. aeruginosa, sensitivity increased (from 46% to 65% and 54% to 63%, respectively; P < .001) and specificity decreased (from 85% to 69% and 76% to 68%; P < .001), with no significant changes in diagnostic odds ratio (decreases from 4.6 to 4.1 [P = .57] and 3.7 to 3.2 [P = .95], respectively).
  
  
  CONCLUSIONS
  Between 2006 and 2010, we found a substantial increase in the use of broad-spectrum antibiotics for pneumonia despite no increase in nosocomial pathogens. The ability of providers to accurately match antibiotic coverage to nosocomial pathogens remains low.
authors.affiliation: Divisions of Pulmonary and Critical Care Medicine.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Jones
authors.affiliation: Epidemiology Infectious Disease.
authors.forename: Makoto M
authors.initials: MM
authors.lastname: Jones
authors.affiliation: Infection Control Program and Division of Infectious Diseases, Geneva University Hospital, Switzerland.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Huttner
authors.affiliation: Division of Epidemiology, University of Utah, Salt Lake City.
authors.forename: Gregory
authors.initials: G
authors.lastname: Stoddard
authors.affiliation: Salt Lake City VA Health System.
authors.forename: Kevin Antoine
authors.initials: KA
authors.lastname: Brown
authors.affiliation: Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah and Salt Lake City VA Health System.
authors.forename: Vanessa W
authors.initials: VW
authors.lastname: Stevens
authors.affiliation: Division of Epidemiology, University of Utah, Salt Lake City.
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.affiliation: Epidemiology.
authors.forename: Brian
authors.initials: B
authors.lastname: Sauer
authors.affiliation: Boise VA Medical Center and Idaho State University College of Pharmacy, Pocatello.
authors.forename: Karl
authors.initials: K
authors.lastname: Madaras-Kelly
authors.affiliation: Epidemiology.
authors.forename: Michael
authors.initials: M
authors.lastname: Rubin
authors.affiliation: Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.affiliation: Epidemiology.
authors.forename: Matthew
authors.initials: M
authors.lastname: Samore
mesh_terms: D000150:Acinetobacter / Q000187:drug effects / Q000302:isolation & purification*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification*; D014728:Veterans
chemical_list: D000900:Anti-Bacterial Agents
keywords: HCAP; antibiotic use; drug-resistant pneumonia; nosocomial pathogens; pneumonia