title: Indications and Types of Antibiotic Agents Used in 6 Acute Care Hospitals, 2009-2010: A Pragmatic Retrospective Observational Study.
abstract: BACKGROUND To design better antimicrobial stewardship programs, detailed data on the primary drivers and patterns of antibiotic use are needed. OBJECTIVE To characterize the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial stewardship programs. DESIGN, PARTICIPANTS, AND SETTING Retrospective medical chart review was performed on a random cross-sectional sample of 1,200 adult inpatients, hospitalized (>24 hrs) in 6 hospitals, and receiving at least 1 antibiotic dose on 4 index dates chosen at equal intervals through a 1-year study period (October 1, 2009-September 30, 2010). METHODS Infectious disease specialists recorded patient demographic characteristics, comorbidities, microbiological and radiological testing, and agents used, dose, duration, and indication for antibiotic prescriptions. RESULTS On the index dates 4,119 (60.5%) of 6,812 inpatients were receiving antibiotics. The random sample of 1,200 case patients was receiving 2,527 antibiotics (average: 2.1 per patient); 540 (21.4%) were prophylactic and 1,987 (78.6%) were therapeutic, of which 372 (18.7%) were pathogen-directed at start. Of the 1,615 empirical starts, 382 (23.7%) were subsequently pathogen-directed and 1,231 (76.2%) remained empirical. Use was primarily for respiratory (27.6% of prescriptions) followed by gastrointestinal (13.1%) infections. Fluoroquinolones, vancomycin, and antipseudomonal penicillins together accounted for 47.1% of therapy-days. CONCLUSIONS Use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities and in most instances was not subsequently pathogen directed. Fluoroquinolones, vancomycin, and antipseudomonal penicillins were the most frequently used antibiotics, particularly for respiratory indications. Infect. Control Hosp. Epidemiol. 2015;37(1):70-79.
authors.affiliation: 1Infectious Diseases,David Geffen School of Medicine/University of California,Los Angeles,Los Angeles,California.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Kelesidis
authors.affiliation: 2Center for Disease Dynamics,Economics & Policy,Washington,DC.
authors.forename: Nikolay
authors.initials: N
authors.lastname: Braykov
authors.affiliation: 1Infectious Diseases,David Geffen School of Medicine/University of California,Los Angeles,Los Angeles,California.
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.affiliation: 2Center for Disease Dynamics,Economics & Policy,Washington,DC.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Morgan
authors.affiliation: 2Center for Disease Dynamics,Economics & Policy,Washington,DC.
authors.forename: Sumanth
authors.initials: S
authors.lastname: Gandra
authors.affiliation: 4Iowa City Veterans Administration Health Care System,Iowa City,Iowa.
authors.forename: Birgir
authors.initials: B
authors.lastname: Johannsson
authors.affiliation: 4Iowa City Veterans Administration Health Care System,Iowa City,Iowa.
authors.forename: Marin L
authors.initials: ML
authors.lastname: Schweizer
authors.affiliation: 5Alta Bates Summit Medical Center,Oakland,California.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Weisenberg
authors.affiliation: 6Denver Health Medical Center,Denver,Colorado.
authors.forename: Heather
authors.initials: H
authors.lastname: Young
authors.affiliation: 7Department of Pediatrics,University of Texas Southwestern,Dallas,Texas.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cantey
authors.affiliation: 4Iowa City Veterans Administration Health Care System,Iowa City,Iowa.
authors.forename: Eli
authors.initials: E
authors.lastname: Perencevich
authors.affiliation: 8Texas A&M Health Science Center College of Medicine,Houston,Texas.
authors.forename: Edward
authors.initials: E
authors.lastname: Septimus
authors.affiliation: 10Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
authors.affiliation: 2Center for Disease Dynamics,Economics & Policy,Washington,DC.
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004927:Escherichia coli Infections / Q000188:drug therapy*; D024841:Fluoroquinolones / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000382:microbiology; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011897:Random Allocation; D012141:Respiratory Tract Infections / Q000188:drug therapy; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000188:drug therapy*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D010406:Penicillins; D014640:Vancomycin