Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016-2017.
Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016-2017.
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DOI：
10.1093/cid/ciaa570
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发表时间：
2021-07-15
期刊：
影响因子：
--
通讯作者：
Harris AD
中科院分区：
文献类型：
--
作者：
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
量化美国医院抗生素使用的数量和多样性有助于抗生素管理工作，但受到国家监督有限的阻碍。我们的研究旨在通过检查576家医院的成人抗生素使用情况和2016-2017年近1200万次接触来解决这一知识差距。我们对2016年1月1日至2017年12月31日期间Premier Healthcare数据库中年龄≥ 18岁的出院患者进行了一项回顾性研究。使用每日抗生素电荷数据，我们将抗生素映射到相互排斥的类别和活性类别谱。我们在负二项回归模型中评估了设施和病例组合特征与抗生素使用之间的关系。该研究包括576家医院的11 701 326例住院患者，共计64 064 632患者日。总体而言，65%的住院患者接受了抗生素治疗，每1000患者日的治疗天数（DOT）为870天。按类别划分，β-内酰胺/β-内酰胺酶抑制剂组合、第三代和第四代头孢菌素和糖肽类药物的使用率最高。教学医院的抗生素总使用率平均低于非教学医院（834 vs 957 DOT/1000患者日; P <0.001）。在调整后的模型中，教学医院仍然与第三代和第四代头孢菌素和抗假单胞菌药物的使用率较低相关（调整后的发病率比[95%置信区间]分别为0.92 [.86-.97]和0.91 [.85-.98]）。在调整后的模型中，总抗生素使用量和类别特异性抗生素使用量的显著区域差异也持续存在。成人住院患者抗生素使用率仍然很高，主要由广谱药物驱动。更好地了解医院间使用差异的原因，包括地区和教学状况，可能有助于减少不适当的抗生素处方。量化美国医院抗生素使用的数量和多样性有助于抗生素管理工作，但受到国家监测有限的阻碍。我们的研究调查了2016-2017年576家医院的成人抗生素使用情况和近1200万次接触。
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. 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. 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. 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. Quantifying the volume and diversity of antibiotic use in United States hospitals assists antibiotic stewardship efforts but is hampered by limited national surveillance. Our study examined adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016–2017.
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