Antibiotic Use in Small Community Hospitals.
BACKGROUND
Antibiotic use and misuse is driving drug resistance. Much of US healthcare takes place in small community hospitals (SCHs); 70% of all US hospitals have <200 beds. Antibiotic use in SCHs is poorly described. We evaluated antibiotic use using data from the National Healthcare and Safety Network antimicrobial use option from the Centers for Disease Control and Prevention.


METHODS
We used Intermountain Healthcare's monthly antibiotic use reports for 19 hospitals from 2011 to 2013. Hospital care units were categorized as intensive care, medical/surgical, pediatric, or miscellaneous. Antibiotics were categorized based on spectrum of coverage. Antibiotic use rates, expressed as days of therapy per 1000 patient-days (DOT/1000PD), were calculated for each SCH and compared with rates in large community hospitals (LCHs). Negative-binomial regression was used to relate antibiotic use to predictor variables.


RESULTS
Total antibiotic use rates varied widely across the 15 SCHs (median, 436 DOT/1000PD; range, 134-671 DOT/1000PD) and were similar to rates in 4 LCHs (509 DOT/1000PD; 406-597 DOT/1000PD). The proportion of patient-days spent in the respective unit types varied substantially within SCHs and had a large impact on facility-level rates. Broad-spectrum antibiotics accounted for 26% of use in SCHs (range, 8%-36%), similar to the proportion in LCHs (32%; range, 26%-37%). Case mix index, proportion of patient-days in specific unit types, and season were significant predictors of antibiotic use.


CONCLUSIONS
There is substantial variation in patterns of antibiotic use among SCHs. Overall usage in SCHs is similar to usage in LCHs. Small hospitals need to become a focus of stewardship efforts.
Division of Clinical Epidemiology and Infectious Diseases.|Division of Infectious Diseases, Stanford University School of Medicine, California.
Edward
E
Stenehjem
Division of Pediatric Infectious Diseases.
Adam L
AL
Hersh
Study Design and Biostatistics Center, University of Utah School of Medicine.
Xiaoming
X
Sheng
Division of Clinical Epidemiology and Infectious Diseases.
Peter
P
Jones
Department of Pharmacy, Intermountain Medical Center, Murray.
Whitney R
WR
Buckel
Medical Informatics, Intermountain Healthcare, Salt Lake City, Utah.
James F
JF
Lloyd
Medical Informatics, Intermountain Healthcare, Salt Lake City, Utah.
Stephen
S
Howe
Biomedical Informatics, University of Utah.|Medical Informatics, Intermountain Healthcare, Salt Lake City, Utah.
R Scott
RS
Evans
Study Design and Biostatistics Center, University of Utah School of Medicine.
Tom
T
Greene
Division of Pediatric Infectious Diseases.
Andrew T
AT
Pavia
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D007061:Idaho / Q000453:epidemiology; D014589:Utah / Q000453:epidemiology
D000900:Anti-Bacterial Agents
antibiotic stewardship; antibiotic use; benchmarking; small community hospital