Antibiotic use in US hospitals: quantification, quality measures and stewardship

Abstract

A majority of patients hospitalized in the US hospitals receive an antibiotic during their hospitalization. Furthermore, up to half of antibiotics prescribed in hospitals are inappropriate. In the setting of continued emergence of antibiotic-resistant pathogens and a limited pipeline of new antimicrobials, attention to optimizing antibiotic use in healthcare settings is essential. We review the measures of antibiotic consumption in the USA, the evolving metrics for comparing antibiotic use (known as benchmarking), trends in antibiotic use, the structure and outcome measures of Antimicrobial Stewardship Programs and interventions to optimize antimicrobial use.

Keywords:

• antimicrobial stewardship
• appropriate use
• benchmarking

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• There is a growing interest in measuring and optimizing antibiotic use in the US hospitals.

• Recent studies from hospital networks and the CDC have utilized days of therapy per 1000-patient days to measure antibiotic consumption, rather than defined daily dose.

• Benchmarking is currently being developed, but is not standardized in the USA. Adequate risk adjustment is an important element to benchmarking.

• Inappropriate use of antibiotics continues to be common in the US hospitals and particular focus has been placed on improving diagnostics, optimizing use of particular classes of antibiotics and reducing redundant microbial coverage of multiple antibiotics.

• Antibiotic stewardship programs are increasingly being developed and the ideal structure of such programs may depend on facility specific resources.

• Measuring the effectiveness of intervention programs may include measuring costs (direct and indirect), antimicrobial outcomes (in use and resistance patterns), but optimally needs to include clinical outcomes.

• Restrictive interventions result in more immediate decreases in antibiotic use but may shift antibiotic use to other antibiotics. Persuasive interventions have longer lasting impact without a compensatory increase in other agents with similar spectrum.

• Improving the utilization of appropriate diagnostics can help ensure antibiotics are being utilized for true bacterial infections. Advances in diagnostics, from quicker identification of bacterial and viral pathogens to biomarkers to help rule out bacterial pathogens, are powerful new tools to improve antibiotic use in the US hospitals.