title: Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014.
abstract: As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed.
authors.affiliation: Health Service Executive (HSE) Health Protection Surveillance Centre (HPSC), Dublin, Ireland.
authors.forename: Ajay
authors.initials: A
authors.lastname: Oza
authors.forename: Fionnuala
authors.initials: F
authors.lastname: Donohue
authors.forename: Howard
authors.initials: H
authors.lastname: Johnson
authors.forename: Robert
authors.initials: R
authors.lastname: Cunney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D019992:Databases as Topic; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007494:Ireland; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D020379:Risk Adjustment; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic use; Benchmarking; Hospital Services; Patient Characteristics