Total inpatient antibiotic use consistent from 2006 to 2012

1. In a retrospective study of over 300 acute care hospitals across the United States, overall days of therapy (DOT) for antibiotic use and proportion of admitted patients receiving antibiotics remained consistent over time from 2006 to 2012.

2. Use of certain antibiotic classes decreased over time, including aminoglycosides, first and second generation cephalosporins, penicillins, sulfa, metronidazole, and fluoroquinolones. Conversely, use of glycopeptides (vancomycin), macrolides, third and fourth generation cephalosporins, tetracyclines, carbapenams, and beta-lactam/beta-lactamase inhibitor combinations increased over the same time period.

Evidence Rating Level: 2 (Good)       

Study Rundown: The rise of antibiotic-resistant organisms and complications of broad-spectrum antibiotic use, such as Clostridium difficile infections, have led to increased focus on antimicrobial stewardship. Reducing inappropriate use of antibiotics, and in particular broad-spectrum agents, is thought to minimize complications and preserve microbial susceptibility. The current study sought to evaluate antibiotic use over time for a large representative sample of US acute care facilities.

Using data from the Truven Health MarketScan Hospital Drug Database from 2006 to 2012, this study evaluated antibiotic use for inpatients admitted to more than 300 participating adult and pediatric hospitals. More than half of all admitted patients received antibiotics during an admission. Over the study period, the days of antibiotic therapy (DOT) per 1000 patient days did not significantly change. DOT was longer for patients in critical care, certain geographic locations, and at non-teaching hospitals. Use of aminoglycosides, first and second generation cephalosporins, penicillins, sulfa, metronidazole, and fluoroquinolones decreased over the study period. However, use of glycopeptides (vancomycin), macrolides, third and fourth generation cephalosporins, tetracyclines, carbapenams, and beta-lactam/beta-lactamase inhibitor combinations increased. The study underscored the growing trend of broad spectrum antibiotic use during this time period. However, this study has several limitations, including reliance on administrative data, using only partial data to determine DOT, and the inability to determine the indications for the antibiotics.

Click to read the study, published today JAMA Internal Medicine

Relevant Reading: Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data

In-Depth [retrospective analysis]: This study used data from 2006 to 2012 from the Truven Health MarketScan Hospital Drug Database (HDD) that included data on discharge diagnostic codes, demographic information, and drug usage data for 300 to 383 hospitals across the United States. Data was included for oral, parenteral, or inhaled antibiotics only, and hospitals not submitting antibiotic usage data were excluded. Antibiotic use was characterized by days of therapy (DOT) per 1000 patient days, and proportion of patients receiving at least one dose of antibiotic during a hospital stay.

During the study period, 55.1% of patients received at least 1 dose of antibiotic during their hospital stay. The DOT was 755 per 1000 patient days, which did not change significantly over time (p = 0.65). DOT was increased for those admitted to critical care (1092 vs. 720 DOT per 1000 patient –days, p < 0.001), geographic location (p < 0.001), and non-teaching hospitals (p = 0.004). The following antibiotic classes had decreased use over time: aminoglycosides, first and second generation cephalosporins, penicillins, sulfa, metronidazole, and fluoroquinolones (p = 0.01 for penicillins, p < 0.001 otherwise). Increased use of the following classes of antibiotics were observed: glycopeptides (vancomycin), macrolides, third and fourth generation cephalosporins, tetracyclines, carbapenams, and beta-lactam/beta-lactamase inhibitor combinations (p = 0.001 for cephalosporins, p < 0.001 otherwise).

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