A novel approach to evaluate antibiotic utilization across the spectrum of inpatient and ambulatory care and implications for prioritization of antibiotic stewardship efforts.
Clin Infect Dis. 2019 Jun 03;:
Authors: Frost HM, Knepper BC, Shihadeh KC, Jenkins TC
BACKGROUND: Antibiotic overuse remains a significant problem. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated health care system in order to prioritize antibiotic stewardship efforts.
METHODS: We conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly-selected days from 2017-2018. For inpatients and perioperative patients administrations of antibiotics were recorded, whereas, prescriptions were recorded for outpatients.
RESULTS: On the study days, 10.9% (95%CI 10.6-11.3%) of patients received antibiotics. Of all antibiotics, 54.1% were from ambulatory care (95%CI 52.6-55.7%), 38.0% were from the hospital, (95%CI 36.6-39.5%), and 7.8% (95%CI 7.1-7.8%) were perioperative. The emergency department/urgent care centers, adult outpatient clinics, and adult non-critical care inpatient wards accounted for 26.4% (95%CI: 25.0-27.7%), 23.8% (95%CI: 22.6-25.2), and 23.9% (95%CI 22.7-25.3) of antibiotic use, respectively. Only 9.2% (95%CI: 8.3-10.1%) of all antibiotics were administered in critical care units. Antibiotics with a broad spectrum of gram-negative activity accounted for 30.4% (95% CI: 29.0-31.9%) of antibiotics. Infections of the respiratory tract were the leading indication for antibiotics.
CONCLUSIONS: In an integrated health care system, over half of antibiotic use occurred in the emergency department/urgent care centers and outpatient clinics. Antibiotics with a broad spectrum of gram-negative activity accounted for a large portion of antibiotic use. Analysis of antibiotic utilization across the spectrum of inpatient and ambulatory care is useful to prioritize antibiotic stewardship efforts.
PMID: 31162539 [PubMed - as supplied by publisher]