Prevalence of Antimicrobial Use in U.S. Acute Care Hospitals, May–September 2011

Details

• Alternative Title:
  JAMA
• Personal Author:
  Magill, Shelley S. ; Edwards, Jonathan R. ; Beldavs, Zintars G. ; Dumyati, Ghinwa ; Janelle, Sarah J. ; Kainer, Marion A. ; Lynfield, Ruth ; Nadle, Joelle ; Neuhauser, Melinda M. ; Ray, Susan M. ; Richards, Katherine ; Rodriguez, Richard ; Thompson, Deborah L. ; Fridkin, Scott K.
• Description:
  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 healthcare settings.
  
  Main Outcome and Measure
  
  Antimicrobial use prevalence, defined as the number of patients on 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 ≥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, while 12.2% (95% CI, 11.5%–12.8%) and 5.9% (95% CI, 5.5%–6.4%) were given for surgical and medical prophylaxis, respectively. 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 healthcare 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 U.S. 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.
  
  
• Keywords:
  Anti-Infective Agents Community-Acquired Infections Cross-Sectional Studies Data Collection Hospitals Humans Infections Inpatients Practice Patterns, Physicians' United States
• Source:
  JAMA. 312(14):1438-1446
• Pubmed ID:
  25291579
• Pubmed Central ID:
  PMC10847977
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  312
• Issue:
  14
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2960f522d39f2087524c9fd8a343d5756456fd8391040402cd6be219a0f5dd50
• Download URL:
  https://stacks.cdc.gov/view/cdc/148982/cdc_148982_DS1.pdf
• File Type:
  [PDF - 126.60 KB ]