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Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016-2017.

Publication ,  Journal Article
Goodman, KE; Cosgrove, SE; Pineles, L; Magder, LS; Anderson, DJ; Dodds Ashley, E; Polk, RE; Quan, H; Trick, WE; Woeltje, KF; Leekha, S; Harris, AD
Published in: Clin Infect Dis
July 15, 2021

BACKGROUND: Quantifying the amount and diversity of antibiotic use in United States hospitals assists antibiotic stewardship efforts but is hampered by limited national surveillance. Our study aimed to address this knowledge gap by examining adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016-2017. METHODS: We conducted a retrospective study of patients aged ≥ 18 years discharged from hospitals in the Premier Healthcare Database between 1 January 2016 and 31 December 2017. Using daily antibiotic charge data, we mapped antibiotics to mutually exclusive classes and to spectrum of activity categories. We evaluated relationships between facility and case-mix characteristics and antibiotic use in negative binomial regression models. RESULTS: The study included 11 701 326 admissions, totaling 64 064 632 patient-days, across 576 hospitals. Overall, patients received antibiotics in 65% of hospitalizations, at a crude rate of 870 days of therapy (DOT) per 1000 patient-days. By class, use was highest among β-lactam/β-lactamase inhibitor combinations, third- and fourth-generation cephalosporins, and glycopeptides. Teaching hospitals averaged lower rates of total antibiotic use than nonteaching hospitals (834 vs 957 DOT per 1000 patient-days; P < .001). In adjusted models, teaching hospitals remained associated with lower use of third- and fourth-generation cephalosporins and antipseudomonal agents (adjusted incidence rate ratio [95% confidence interval], 0.92 [.86-.97] and 0.91 [.85-.98], respectively). Significant regional differences in total and class-specific antibiotic use also persisted in adjusted models. CONCLUSIONS: Adult inpatient antibiotic use remains high, driven predominantly by broad-spectrum agents. Better understanding reasons for interhospital usage differences, including by region and teaching status, may inform efforts to reduce inappropriate antibiotic prescribing.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

July 15, 2021

Volume

73

Issue

2

Start / End Page

213 / 222

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Patient Discharge
  • Microbiology
  • Humans
  • Hospitals
  • Antimicrobial Stewardship
  • Anti-Bacterial Agents
  • Adult
  • 3202 Clinical sciences
 

Citation

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Goodman, K. E., Cosgrove, S. E., Pineles, L., Magder, L. S., Anderson, D. J., Dodds Ashley, E., … Harris, A. D. (2021). Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016-2017. Clin Infect Dis, 73(2), 213–222. https://doi.org/10.1093/cid/ciaa570
Goodman, Katherine E., Sara E. Cosgrove, Lisa Pineles, Laurence S. Magder, Deverick J. Anderson, Elizabeth Dodds Ashley, Ronald E. Polk, et al. “Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016-2017.Clin Infect Dis 73, no. 2 (July 15, 2021): 213–22. https://doi.org/10.1093/cid/ciaa570.
Goodman KE, Cosgrove SE, Pineles L, Magder LS, Anderson DJ, Dodds Ashley E, et al. Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016-2017. Clin Infect Dis. 2021 Jul 15;73(2):213–22.
Goodman, Katherine E., et al. “Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016-2017.Clin Infect Dis, vol. 73, no. 2, July 2021, pp. 213–22. Pubmed, doi:10.1093/cid/ciaa570.
Goodman KE, Cosgrove SE, Pineles L, Magder LS, Anderson DJ, Dodds Ashley E, Polk RE, Quan H, Trick WE, Woeltje KF, Leekha S, Harris AD. Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016-2017. Clin Infect Dis. 2021 Jul 15;73(2):213–222.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

July 15, 2021

Volume

73

Issue

2

Start / End Page

213 / 222

Location

United States

Related Subject Headings

  • United States
  • Retrospective Studies
  • Patient Discharge
  • Microbiology
  • Humans
  • Hospitals
  • Antimicrobial Stewardship
  • Anti-Bacterial Agents
  • Adult
  • 3202 Clinical sciences