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JAMA. 2014 Oct 8;312(14):1438-46. doi: 10.1001/jama.2014.12923.

Prevalence of antimicrobial use in US acute care hospitals, May-September 2011.

Author information

1
Centers for Disease Control and Prevention, Atlanta, Georgia.
2
Oregon Public Health Division, Oregon Health Authority, Portland.
3
New York-Rochester Emerging Infections Program and University of Rochester Medical Center, Rochester.
4
Colorado Department of Public Health and Environment, Denver.
5
Tennessee Department of Health, Nashville.
6
Minnesota Department of Health, St Paul.
7
California Emerging Infections Program, Oakland.
8
Centers for Disease Control and Prevention, Atlanta, Georgia8Department of Veterans Affairs Pharmacy Benefits Management Services, Hines, Illinois.
9
Georgia Emerging Infections Program, Atlanta Veterans Affairs Medical Center, Decatur10Georgia Emerging Infections Program, Emory University School of Medicine, Atlanta.
10
Maryland Department of Health and Mental Hygiene, Baltimore.
11
Connecticut Department of Public Health, Hartford.
12
New Mexico Department of Health, Santa Fe.

Abstract

IMPORTANCE:

Inappropriate antimicrobial drug use is associated with adverse events in hospitalized patients and contributes to the emergence and spread of resistant pathogens. Targeting effective interventions to improve antimicrobial use in the acute care setting requires understanding hospital prescribing practices.

OBJECTIVE:

To determine the prevalence of and describe the rationale for antimicrobial use in participating hospitals.

DESIGN, SETTING, AND PARTICIPANTS:

One-day prevalence surveys were conducted in acute care hospitals in 10 states between May and September 2011. Patients were randomly selected from each hospital's morning census on the survey date. Data collectors reviewed medical records retrospectively to gather data on antimicrobial drugs administered to patients on the survey date and the day prior to the survey date, including reasons for administration, infection sites treated, and whether treated infections began in community or health care settings.

MAIN OUTCOMES AND MEASURES:

Antimicrobial use prevalence, defined as the number of patients receiving antimicrobial drugs at the time of the survey divided by the total number of surveyed patients.

RESULTS:

Of 11,282 patients in 183 hospitals, 5635 (49.9%; 95% CI, 49.0%-50.9%) were administered at least 1 antimicrobial drug; 77.5% (95% CI, 76.6%-78.3%) of antimicrobial drugs were used to treat infections, most commonly involving the lower respiratory tract, urinary tract, or skin and soft tissues, whereas 12.2% (95% CI, 11.5%-12.8%) were given for surgical and 5.9% (95% CI, 5.5%-6.4%) for medical prophylaxis. Of 7641 drugs to treat infections, the most common were parenteral vancomycin (1103, 14.4%; 95% CI, 13.7%-15.2%), ceftriaxone (825, 10.8%; 95% CI, 10.1%-11.5%), piperacillin-tazobactam (788, 10.3%; 95% CI, 9.6%-11.0%), and levofloxacin (694, 9.1%; 95% CI, 8.5%-9.7%). Most drugs administered to treat infections were given for community-onset infections (69.0%; 95% CI, 68.0%-70.1%) and to patients outside critical care units (81.6%; 95% CI, 80.4%-82.7%). The 4 most common treatment antimicrobial drugs overall were also the most common drugs used for both community-onset and health care facility-onset infections and for infections in patients in critical care and noncritical care locations.

CONCLUSIONS AND RELEVANCE:

In this cross-sectional evaluation of antimicrobial use in US hospitals, use of broad-spectrum antimicrobial drugs such as piperacillin-tazobactam and drugs such as vancomycin for resistant pathogens was common, including for treatment of community-onset infections and among patients outside critical care units. Further work is needed to understand the settings and indications for which reducing antimicrobial use can be most effectively and safely accomplished.

PMID:
25291579
DOI:
10.1001/jama.2014.12923
[Indexed for MEDLINE]

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