Uslan DZ, Kelesidis T, Braykov NB, Morgan DJ, Johannsson B , Schweizer ML, Weisenberg SA, Young H, Cantey JB, Perencevich EN, Septimus EJ, Srinivasan A, Laxminarayn R. Indications and Types of Antibiotic Use In Six Acute-Care Hospitals: Results from a Multicenter Cross-Sectional Study (Poster #768). IDWeek. October 2012. San Diego, CA.
Antimicrobial stewardship programs (ASPs) are hampered by lack of detailed multicenter data on the primary drivers and classes of antibiotic use. We conducted a retrospective study to identify the types and indications for antibiotic prescribing in 6 different acute-care facilities.
Cross-sectional study using retrospective chart review of 1,200 adult inpatients, hospitalized (>24hrs) in Veterans Affairs (n=1), teaching (n =2), non-teaching hospitals (n=3), and receiving >=1 antibiotic doses on 4 index dates chosen at equal intervals through a 1-year study period (9/2009-10/2010). Infectious disease (ID) specialists recorded patient demographics, comorbidities, microbiological and radiological work-up, and dose, duration and indication for antibiotic prescriptions (rxs). Prescriptions were categorized as: 1) prophylactic (e.g. perioperative, transplant, AIDS); 2) therapeutic, divided into pathogen-directed at start, and empiric (including empiric throughout, and subsequently pathogen-directed).
On the index dates 4,119/6,812 inpatients (59.8%) were receiving antibiotics. Of these, 1,200 adult cases were randomly selected for review, receiving 2,528 antibiotic rxs (average: 2.1 per patient), 30% of which were administered in combination; 540 (21.4%) of rxs were prophylactic and 1,988 (78.6%) were therapeutic; of these, 372 (18.7%) were pathogen-directed at start and 1,616 (81.3%) were started as empiric; of empiric starts, 382 (23.7%) were subsequently pathogen-directed, and 1,232 (76.3%) remained empiric. Use was primarily for respiratory (27.6% of rxs and 28.8% of therapy days) followed by gastro-intestinal (13.1% and 14.8%) and bloodstream (10.8% and 12.8%) infections. Fluoroquinolones, vancomycin and antipseudomonal penicillins were the most frequently prescribed antibiotics, together accounting for 47.3% of therapy days and 47% of therapeutic rxs.
Use of broad-spectrum empiric therapy is prevalent in US acute care facilities, and in the majority of cases is not subsequently pathogen-directed. Prophylactic use accounted for 1/5 of antibiotic prescriptions. ASPs targeted at appropriate utilization of vancomycin, fluoroquinolones, and piperacillin/tazobactam hold the greatest potential to reduce antibiotic use.