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Clin Infect Dis. 2015 Nov 1;61(9):1403-10. doi: 10.1093/cid/civ629. Epub 2015 Jul 29.

Trends in Antibiotic Use and Nosocomial Pathogens in Hospitalized Veterans With Pneumonia at 128 Medical Centers, 2006-2010.

Author information

1
Divisions of Pulmonary and Critical Care Medicine.
2
Epidemiology Infectious Disease.
3
Infection Control Program and Division of Infectious Diseases, Geneva University Hospital, Switzerland.
4
Division of Epidemiology, University of Utah, Salt Lake City.
5
Salt Lake City VA Health System.
6
Pharmacotherapy Outcomes Research Center, College of Pharmacy, University of Utah and Salt Lake City VA Health System.
7
Epidemiology.
8
Boise VA Medical Center and Idaho State University College of Pharmacy, Pocatello.
9
Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, Los Angeles, California.

Abstract

BACKGROUND:

In 2005, pneumonia practice guidelines recommended broad-spectrum antibiotics for patients with risk factors for nosocomial pathogens. The impact of these recommendations on the ability of providers to match treatment with nosocomial pathogens is unknown.

METHODS:

Among hospitalizations with a principal diagnosis of pneumonia at 128 Department of Veterans Affairs medical centers from 2006 through 2010, we measured annual trends in antibiotic selection; initial blood or respiratory cultures positive for methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Acinetobacter species; and alignment between antibiotic coverage and culture results for MRSA and P. aeruginosa, calculating sensitivity, specificity, and diagnostic odds ratio using a 2 × 2 contingency table.

RESULTS:

In 95 511 hospitalizations for pneumonia, initial use of vancomycin increased from 16% in 2006 to 31% in 2010, and piperacillin-tazobactam increased from 16% to 27%, and there was a decrease in both ceftriaxone (from 39% to 33%) and azithromycin (change from 39% to 36%) (P < .001 for all). The proportion of hospitalizations with cultures positive for MRSA decreased (from 2.5% to 2.0%; P < .001); no change was seen for P. aeruginosa (1.9% to 2.0%; P = .14) or Acinetobacter spp. (0.2% to 0.2%; P = .17). For both MRSA and P. aeruginosa, sensitivity increased (from 46% to 65% and 54% to 63%, respectively; P < .001) and specificity decreased (from 85% to 69% and 76% to 68%; P < .001), with no significant changes in diagnostic odds ratio (decreases from 4.6 to 4.1 [P = .57] and 3.7 to 3.2 [P = .95], respectively).

CONCLUSIONS:

Between 2006 and 2010, we found a substantial increase in the use of broad-spectrum antibiotics for pneumonia despite no increase in nosocomial pathogens. The ability of providers to accurately match antibiotic coverage to nosocomial pathogens remains low.

KEYWORDS:

HCAP; antibiotic use; drug-resistant pneumonia; nosocomial pathogens; pneumonia

PMID:
26223995
PMCID:
PMC4599396
DOI:
10.1093/cid/civ629
[Indexed for MEDLINE]
Free PMC Article

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