title: Appropriate antibiotic use reduces length of hospital stay.
abstract: To define appropriate antibiotic use in hospitalized adults treated for a bacterial infection, we previously developed and validated a set of six generic quality indicators (QIs) covering all steps in the process of antibiotic use. We assessed the association between appropriate antibiotic use, defined by these QIs, and length of hospital stay (LOS).
  
  
  
  An observational multicentre study in 22 hospitals in the Netherlands included 1890 adult, non-ICU patients using antibiotics for a suspected bacterial infection. Performance scores were calculated for all QIs separately (appropriate or not), and a sum score described performance on the total set of QIs. We divided the sum scores into two groups: low (0%-49%) versus high (50%-100%). Multilevel analyses, correcting for confounders, were used to correlate QI performance (single and combined) with (log-transformed) LOS and in-hospital mortality.
  
  
  
  The only single QI associated with shorter LOS was appropriate intravenous-oral switch (geometric means 6.5 versus 11.2 days; P  < 0.001). A high sum score was associated with a shorter LOS in the total group (10.1 versus 11.2 days; P  = 0.002) and in the subgroup of community-acquired infections (9.7 versus 10.9 days; P  =   0.007), but not in the subgroup of hospital-acquired infections. We found no association between performance on QIs and in-hospital mortality or readmission rate.
  
  
  
  Appropriate antibiotic use, defined by validated process QIs, in hospitalized adult patients with a suspected bacterial infection appears to be associated with a shorter LOS and therefore positively contributes to patient outcome and healthcare costs.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, The Netherlands.
authors.forename: Caroline M A
authors.initials: CM
authors.lastname: van den Bosch
authors.affiliation: Department of Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
authors.affiliation: Department of Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
authors.forename: Reinier P
authors.initials: RP
authors.lastname: Akkermans
authors.affiliation: Department of Center for Infectious Diseases, Epidemiology and Surveillance, The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Wille
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, The Netherlands.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, The Netherlands.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000188:drug therapy; D005260:Female; D017048:Health Care Costs; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019984:Quality Indicators, Health Care
chemical_list: D000900:Anti-Bacterial Agents