Assessment of the Appropriateness of Antimicrobial Use in US Hospitals

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dc.contributor.authorMagill, Shelley S.
dc.contributor.authorO’Leary, Erin
dc.contributor.authorRay, Susan M.
dc.contributor.authorKainer, Marion A.
dc.contributor.authorWilson, Lucy E.
dc.contributor.authorEmerging Infections Program Hospital Prevalence Survey Team
dc.contributor.authoret al
dc.date.accessioned2021-04-07T18:57:46Z
dc.date.available2021-04-07T18:57:46Z
dc.date.issued2021-03-18
dc.descriptionAuthors: Shelley S. Magill, Erin O’Leary, Susan M. Ray, Marion A. Kainer, Christopher Evans, Wendy M. Bamberg, Helen Johnston, Sarah J. Janelle, Tolulope Oyewumi, Ruth Lynfield, Jean Rainbow, Linn Warnke, Joelle Nadle, Deborah L. Thompson, Shamima Sharmin, Rebecca Pierce, Alexia Y. Zhang, Valerie Ocampo, Meghan Maloney, Samantha Greissman, Lucy E. Wilson, Ghinwa Dumyati, Jonathan R. Edwards, Nora Chea, Melinda M. Neuhauser; Emerging Infections Program Hospital Prevalence Survey Team:Karen Click, Linda Frank, Deborah Godine, Brittany Martin, Erin Parker, Lauren Pasutti, Sarabeth Friedman, Annika Jones, Tabetha Kosmicki, James Fisher, Amber Maslar, James Meek, Richard Melchreit, Farzana Badrun, Lauren Epstein, Ryan Fagan, Anthony Fiore, Nicole R. Gualandi, Arjun Srinivasan, Scott K. Fridkin, Susan L. Morabit, Lewis A. Perry, Rebecca Perlmutter, Elisabeth Vaeth, Annastasia Gross, Jane Harper, Brittany Pattee, Nabeelah Rahmathullah, Joan Baumbach, Marla Sievers, Cathleen Concannon, Christina Felsen, Anita Gellert, Monika Samper, Raphaelle H. Beard, Patricia Lawson, Daniel Muleta, Vicky P. Reed
dc.description.abstractImportance Hospital antimicrobial consumption data are widely available; however, large-scale assessments of the quality of antimicrobial use in US hospitals are limited. Objective To evaluate the appropriateness of antimicrobial use for hospitalized patients treated for community-acquired pneumonia (CAP) or urinary tract infection (UTI) present at admission or for patients who had received fluoroquinolone or intravenous vancomycin treatment. Design, Setting, and Participants This cross-sectional study included data from a prevalence survey of hospitalized patients in 10 Emerging Infections Program sites. Random samples of inpatients on hospital survey dates from May 1 to September 30, 2015, were identified. Medical record data were collected for eligible patients with 1 or more of 4 treatment events (CAP, UTI, fluoroquinolone treatment, or vancomycin treatment), which were selected on the basis of common infection types reported and antimicrobials given to patients in the prevalence survey. Data were analyzed from August 1, 2017, to May 31, 2020. Exposure Antimicrobial treatment for CAP or UTI or with fluoroquinolones or vancomycin. Main Outcomes and Measures The percentage of antimicrobial use that was supported by medical record data (including infection signs and symptoms, microbiology test results, and antimicrobial treatment duration) or for which some aspect of use was unsupported. Unsupported antimicrobial use was defined as (1) use of antimicrobials to which the pathogen was not susceptible, use in the absence of documented infection signs or symptoms, or use without supporting microbiologic data; (2) use of antimicrobials that deviated from recommended guidelines; or (3) use that exceeded the recommended duration. Results Of 12 299 patients, 1566 patients (12.7%) in 192 hospitals were included; the median age was 67 years (interquartile range, 53-79 years), and 864 (55.2%) were female. A total of 219 patients (14.0%) were included in the CAP analysis, 452 (28.9%) in the UTI analysis, 550 (35.1%) in the fluoroquinolone analysis, and 403 (25.7%) in the vancomycin analysis; 58 patients (3.7%) were included in both fluoroquinolone and vancomycin analyses. Overall, treatment was unsupported for 876 of 1566 patients (55.9%; 95% CI, 53.5%-58.4%): 110 of 403 (27.3%) who received vancomycin, 256 of 550 (46.6%) who received fluoroquinolones, 347 of 452 (76.8%) with a diagnosis of UTI, and 174 of 219 (79.5%) with a diagnosis of CAP. Among patients with unsupported treatment, common reasons included excessive duration (103 of 174 patients with CAP [59.2%]) and lack of documented infection signs or symptoms (174 of 347 patients with UTI [50.1%]). Conclusions and Relevance The findings suggest that standardized assessments of hospital antimicrobial prescribing quality can be used to estimate the appropriateness of antimicrobial use in large groups of hospitals. These assessments, performed over time, may inform evaluations of the effects of antimicrobial stewardship initiatives nationally.en_US
dc.description.sponsorshipObtained funding: Magill, Bamberg, Maloney, Dumyati. The Emerging Infections Program Hospital Prevalence Survey of Healthcare-associated Infections and Antimicrobial Use was supported by the CDC through the Emerging Infections Program Cooperativeen_US
dc.description.urihttps://jamanetwork.com/journals/jamanetworkopen/article-abstract/2777635en_US
dc.format.extent16 pagesen_US
dc.genrejournal articlesen_US
dc.identifierdoi:10.13016/m2atpv-sdj7
dc.identifier.citationMagill SS, O’Leary E, Ray SM, et al. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals. JAMA Netw Open. 2021;4(3):e212007. doi:10.1001/jamanetworkopen.2021.2007en_US
dc.identifier.urihttps://doi.org/10.1001/jamanetworkopen.2021.2007
dc.identifier.urihttp://hdl.handle.net/11603/21296
dc.language.isoen_USen_US
dc.publisherJAMAen_US
dc.relation.isAvailableAtThe University of Maryland, Baltimore County (UMBC)
dc.relation.ispartofUMBC Emergency Health Services Department Collection
dc.relation.ispartofUMBC Faculty Collection
dc.rightsThis work was written as part of one of the author's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.
dc.rightsPublic Domain Mark 1.0*
dc.rights.urihttps://creativecommons.org/publicdomain/mark/1.0/*
dc.titleAssessment of the Appropriateness of Antimicrobial Use in US Hospitalsen_US
dc.typeTexten_US

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