Abstract
Background
The National Action Plan for Combating Antibiotic-resistant Bacteria calls for monitoring inpatient antibiotic use to inform stewardship efforts. We estimated national trends in inpatient antibiotic usage from 2012 to 2017 in a large cohort of US hospitals.
Methods
We utilized the Premier Healthcare Database, containing detailed administrative records available by census region, including inpatient drug utilization data based on billing records, for all patients discharged from a convenience sample of over 700 US hospitals annually, approximately 20% of US inpatient discharges. We retrospectively estimated days of therapy (DOT)/1,000 patient-days (PDs) by year overall and by antibiotic class. To examine trends over time, we created multivariable models adjusting for hospital-specific location of antibiotic use (ICU vs. other) and hospital-specific summary measures including average patient age, average co-morbidity score, case mix index, number of hospital beds, teaching status, urban/rural location, US census division, proportion of discharges with a surgical diagnosis-related code, and proportion of PDs with an infectious disease primary ICD-9/10-CM discharge code. Estimates and models were weighted to be nationally representative using projected weights from the database.
Results
58% of patients had at least one antibiotic DOT, and the overall DOT for all hospitals was 810 DOT/1,000 PDs (interquartile range 701 to 913 DOT/1,000 PDs). Glycopeptides and third-/fourth-generation cephalosporins were the most common antibiotic classes (Figure 1). Overall antibiotic DOT did not change significantly over time, P = 0.9133. However, class-specific DOT varied with large decreases in fluoroquinolones from 2012 to 2017 (55% decrease, P < 0.0001), and large increases in third-/fourth-generation cephalosporins and tetracyclines (32% and 49% increase, respectively, P < 0.0001) (Figure 2). Overall antibiotic DOT significantly varied among US census divisions (Figure 3).
Conclusion
Estimated overall inpatient antibiotic DOT did not change in US hospitals from 2012 to 2017, but there were significant class-specific changes. The large decrease in fluoroquinolone use may reflect increased awareness of adverse events.
Disclosures
All Authors: No reported Disclosures.