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- Title
Antibiotic Use in Small Community Hospitals.
- Authors
Stenehjem, Edward; Hersh, Adam L.; Xiaoming Sheng; Jones, Peter; Buckel, Whitney R.; Lloyd, James F.; Howe, Stephen; Evans, R. Scott; Greene, Tom; Pavia, Andrew T.
- Abstract
Background. Antibiotic use and misuse is driving drug resistance. Much of US healthcare takes place in small community hospitals (SCHs); 70% of all US hospitals have <200 beds. Antibiotic use in SCHs is poorly described. We evaluated antibiotic use using data from the National Healthcare and Safety Network antimicrobial use option from the Centers for Disease Control and Prevention. Methods. We used Intermountain Healthcare's monthly antibiotic use reports for 19 hospitals from 2011 to 2013. Hospital care units were categorized as intensive care, medical/surgical, pediatric, or miscellaneous. Antibiotics were categorized based on spectrum of coverage. Antibiotic use rates, expressed as days of therapy per 1000 patient-days (DOT/1000PD), were calculated for each SCH and compared with rates in large community hospitals (LCHs). Negative-binomial regression was used to relate antibiotic use to predictor variables. Results. Total antibiotic use rates varied widely across the 15 SCHs (median, 436 DOT/1000PD; range, 134-671 DOT/1000PD) and were similar to rates in 4 LCHs (509DOT/1000PD; 406-597DOT/1000PD). The proportion of patient-days spent in the respective unit types varied substantially within SCHs and had a large impact on facility-level rates. Broad-spectrum antibiotics accounted for 26% of use inSCHs (range,8%-36%), similar to the proportion in LCHs (32%; range, 26%-37%). Case mix index, proportion of patient-days in specific unit types, and season were significant predictors of antibiotic use. Conclusions. There is substantial variation in patterns of antibiotic use among SCHs. Overall usage in SCHs is similar to usage in LCHs. Small hospitals need to become a focus of stewardship efforts.
- Subjects
UNITED States; ANTIBIOTICS; DRUG resistance; DRUG abuse; PUBLIC health; HOSPITAL care; PREVENTIVE medicine
- Publication
Clinical Infectious Diseases, 2016, Vol 63, Issue 10, p1273
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciw588