Significant Regional Differences in Antibiotic Use Across 576 U.S. Hospitals and 11,701,326 Million Adult Admissions, 2016 - 2017.
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 January 1, 2016 - December 31, 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 (DOTs) per 1000 patient-days. By class, use was highest among beta-lactam/beta-lactamase inhibitor combinations, third- and fourth-generation cephalosporins, and glycopeptides. Teaching hospitals averaged lower rates of total antibiotic use than non-teaching hospitals (834 versus 957 DOTS per 1000 patient-days; P<0.001). In adjusted models, teaching hospitals remained associated with lower use of third- and fourth-generation cephalosporins and anti-pseudomonal agents (aIRRs: 0.92 [0.86 - 0.97] and 0.91 [0.85 - 0.98], 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 inter-hospital usage differences, including by region and teaching status, may inform efforts to reduce inappropriate antibiotic prescribing.
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
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