Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011

• Type of Material: Article
• Authors: Shelley S Magill, Centers for Disease Control and Prevention, Atlanta; Erin O'Leary, Centers for Disease Control and Prevention, Atlanta; Susan Ray, Emory University; Marion Kainer, Tennessee Department of Health, Nashville; Christopher Evans, Tennessee Department of Health, Nashville; Wendy M Bamberg, Colorado Department of Public Health and Environment, Denver; Helen Johnston, Colorado Department of Public Health and Environment, Denver; Sarah J Janelle, Colorado Department of Public Health and Environment, Denver; Tolulope Oyewumi, Colorado Department of Public Health and Environment, Denver; Ruth Lynfield, Minnesota Department of Health, St Paul; Jean Rainbow, Minnesota Department of Health, St Paul; Linn Warnke, Minnesota Department of Health, St Paul; Joelle Nadle, California Emerging Infections Program; Deborah L Thompson, New Mexico Department of Health, Santa Fe; Shamima Sharmin, New Mexico Department of Health, Santa Fe; Rebecca Pierce, Oregon Health Authority, Portland; Alexia Y Zhang, Oregon Health Authority, Portland; Valerie Ocampo, Oregon Health Authority, Portland; Meghan Maloney, Connecticut Emerging Infect Program; Samantha Greissman, Connecticut Emerging Infect Program; Lucy E Wilson, Maryland Department of Health and University of Maryland Baltimore County; Ghinwa Dumyati, New York Emerging Infect Program; Jonathan R Edwards, Centers for Disease Control and Prevention, Atlanta
• Language: English
• Date: 2021-05-15
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020, Published by Oxford University Press for the Infectious Diseases Society of America 2020.
• Final Published Version (URL): http://dx.doi.org/10.1093/cid/ciaa373
• Title of Journal or Parent Work: CLINICAL INFECTIOUS DISEASES
• Volume: 72
• Issue: 10
• Start Page: 1784
• End Page: 1792
• Grant/Funding Information: This work was supported by the Centers for Disease Control and Prevention through the Emerging Infections Program Cooperative Agreement CK17-1701.
• Keywords: EARLY-ONSET SEPSIS; hospitals; ANTIBIOTIC STEWARDSHIP PROGRAMS; STATE; ACUTE-CARE HOSPITALS; Infectious Diseases; CLOSTRIDIUM-DIFFICILE INFECTION; MANAGEMENT; Science & Technology; Immunology; prevalence; Life Sciences & Biomedicine; RISK; IMPACT; epidemiology; ESCHERICHIA-COLI; antimicrobial stewardship; anti-infective agents; Microbiology

Abstract

Background: In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. Methods: The Centers for Disease Control and Prevention's Emerging Infections Program sites in 10 states each recruited ≤25 general and women's and children's hospitals. Hospitals selected a survey date from May-September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. Results: Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6-50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P =. 006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P <. 001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P =. 002), as was carbapenem use (3.7% vs 2.7% [2011]; P <. 001). Conclusions: Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.