Antibiotic Use in Small Community Hospitals

Stenehjem, Edward; Hersh, Adam L.; Sheng, Xiaoming; Jones, Peter; Buckel, Whitney R.; Lloyd, James F.; Howe, Stephen E.; Evans, R. Scott; Greene, Tom; Pavia, Andrew T.

doi:10.1093/cid/ciw588

Cited by 58 publications

(34 citation statements)

References 28 publications

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“…Recently, there have been some examples in the literature of methods to determine the breadth of antibiotic exposure [12, 26], including the ASI [25]. In our pilot, we attempted to enhance conventional PPS metrics by including ASI normalized by patient cases.…”

Section: Discussionmentioning

confidence: 99%

“…The ASI was developed to categorize antibiotics based on their activity against clinically important organisms to benchmark utilization patterns across hospitals and is intended to provide a measure of the breadth of antibiotic exposure. Although there are several methods in the literature that provide similar measures [12, 26], the ASI was selected as it could be calculated using information already collected as part of the PPS. Mean patient ASI was determined for each hospital and by indication per patient case.…”

Section: Methodsmentioning

confidence: 99%

“…Although there have been several large PPS of hospital AMU in the United States [11, 12], Europe [13], Australia [14, 15], and elsewhere [16, 17], PPS of Canadian hospitals are more limited, and are particularly lacking for nonacademic centers [18–20]. To our knowledge, there is also only 1 example of a provincial PPS, conducted in New Brunswick in 2012 [21, 22].…”

mentioning

confidence: 99%

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Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study

Leung

Langford

et al. 2018

Open Forum Infectious Diseases

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BackgroundAntimicrobial stewardship, a key component of an overall strategy to address antimicrobial resistance, has been recognized as a global priority. The ability to track and benchmark antimicrobial use (AMU) is critical to advancing stewardship from an organizational and provincial perspective. As there are few comprehensive systems in Canada that allow for benchmarking, Public Health Ontario conducted a pilot in 2016/2017 to assess the feasibility of using a point prevalence methodology as the basis of a province-wide AMU surveillance program.MethodsThree acute care hospitals of differing sizes in Ontario, Canada, participated. Adults admitted to inpatient acute care beds on the survey date were eligible for inclusion; a sample size of 170 per hospital was targeted, and data were collected for the 24-hour period before and including the survey date. Debrief sessions at each site were used to gather feedback about the process. Prevalence of AMU and the Antimicrobial Spectrum Index (ASI) was reported for each hospital and by indication per patient case.ResultsParticipants identified required improvements for scalability including streamlining ethics, data sharing processes, and enhancing the ability to compare with peer organizations at a provincial level. Of 457 patients, 172 (38%) were receiving at least 1 antimicrobial agent. Beta-lactam/beta-lactamase inhibitors were the most common (18%). The overall mean ASI per patient was 6.59; most cases were for treatment of infection (84%).ConclusionsThis pilot identified factors and features required for a scalable provincial AMU surveillance program; future efforts should harmonize administrative processes and enable interfacility benchmarking.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study

Leung

Langford

et al. 2018

Open Forum Infectious Diseases

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“…A recent study from Utah compared antibiotic use in small hospitals to large community hospitals in the same network [9]. Usage rates and spectrum of antibiotics used were no different when comparing small to large facilities.…”

Section: The Need For Antibiotic Stewardship In Small Hospitalsmentioning

confidence: 99%

Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions

Stenehjem

Hyun

Septimus

et al. 2017

Clinical Infectious Diseases

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“…admissions. We defined broad-spectrum agents according to the classification proposed by Stenehjem et al 4 The following agents or classes met that definition: aminoglycosides, fluoroquinolones, aztreonam, ceftazidime, cefepime, ceftaroline, vancomycin, piperacillin-tazobactam, carbapenems, polymyxins, linezolid and daptomycin.…”

Section: Methodsmentioning

confidence: 99%

Use of parenteral antimicrobials in very small hospitals in inner Brazil: patterns, determinants, and opportunities for interventions in developing countries

Giacomini

Fortaleza

2017

Journal of Hospital Infection

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Much of healthcare in developing countries takes place in small hospitals. Little is known about the use of antimicrobials in those settings. We studied the 60-day use of parenteral antimicrobials in 48 hospitals with up to 50 beds in inner Brazil. The overall use was 242.0 defined daily doses per 100 admissions, and broad-spectrum agents accounted for 26.8%. The existence of local guidelines, educational measures and restrictive policies for antimicrobial prescriptions, as well as infection control and microbiology resources, were significantly associated with lesser use. Those findings point to possible interventions aimed at preventing antimicrobial over-use in developing countries.

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Antibiotic Use in Small Community Hospitals

Abstract: There is substantial variation in patterns of antibiotic use among SCHs. Overall usage in SCHs is similar to usage in LCHs. Small hospitals need to become a focus of stewardship efforts.

Cited by 58 publications

References 28 publications

Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study

Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study

Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions

Use of parenteral antimicrobials in very small hospitals in inner Brazil: patterns, determinants, and opportunities for interventions in developing countries

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