Antibiotic use prevalent among hospitalized patients in the US

1. About 50% of hospitalized individuals in the United States received antibiotics in 2011.

2. Vancomycin was the most commonly used antibiotic for community and hospital acquired infections in critical care and non-critical care settings in the United States in 2011.

Evidence Rating Level: 4 (Below Average)

Study Rundown: Antibiotics have saved countless lives, but inappropriate use of antibiotics can harm patients and promote drug-resistant organisms. An initial step in evaluating the efficacy of antibiotic usage is to characterize antibiotic administration patterns. This study analyzed hospital antibiotic use data from hospitals in 10 states that were included in the Emerging Infection Program of the Centers of Disease Control and Prevention in 2011. Data was collected from small (<150 beds), medium (150-399 beds), and large (>400 beds) hospitals based on whether a patient was scheduled to receive antibiotics on the day of or before the survey, the patient was on dialysis and getting antibiotics within the 4 days prior to the survey day, or the patient’s antibiotic data was unknown for the survey day. Charts of patients meeting one of these criteria were reviewed for the antibiotic administered and the indication for its use.

Antibiotics were administered to about 50% of patients. Vancomycin was the most commonly administered antibiotic for both community (13.7%) and hospital-acquired (15.9%) infections. Vancomycin was also the most commonly used antibiotic in both critical care (34.9%) and non-critical care (23.7%) settings, followed by piperacillin-tazobactam in critical care settings (25.6%) and ceftriaxone in non-critical care settings (20.2%). Strengths of this study include the careful analysis of patients’ records, the inclusion of hospitals of multiple sizes from 10 states across the United States, and the inclusion of the indication for antibiotic use. One weakness of the study is that the data is from 2011, and may not reflect the most recent trends in antimicrobial therapy. Thus, while this study demonstrated that broad-spectrum antibiotics that are effective against highly resistant organisms are commonly used, further research is required to understand when and how frequently these agents are used in order to curb inappropriate administration.

Click to read the study, published today in JAMA

Relevant Reading: Vital signs: improving antibiotic use among hospitalized patients.

In-Depth [cross-sectional study]: This study analyzed antibiotic use and rationale for use data from 183 small, medium, or large hospitals across 10 states in 2011. Antibiotics were administered to 49.9% of patients (95%CI 49.0-50.9). Of these patients, 75.9% (95%CI 74.8-77.0) were receiving antibiotics to treat an infection. The remainder of patients received antibiotics for prophylaxis (medical 6.9%; surgical 19.0%) or for non-infectious (0.71%) or undocumented reasons (6.9%). Vancomycin was the most commonly used antibiotic for community- (13.7%) and hospital-acquired infections (15.9%) in both critical (34.9%) and non-critical (23.7%) care settings. This was followed by piperacillin-tazobactam in critical care settings (25.6%) and ceftriaxone in non-critical care settings (20.2%).

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