1820. Indirect Standardization: A Convenient Benchmarking Approach to Antibiotic Utilization Based on Patient Mix

Abstract Background Antibiotic resistance poses a significant threat to public health globally. Irrational utilization of antibiotics being one of the main reasons of antibiotic resistant. Children as a special group, there's more chance of getting infected. Although most of the infection is viral in etiology, antibiotics still are the most frequently prescribed medications for children. Therefore, high use of antibiotics among children raises concern about the appropriateness of antibiotic prescribing. This systematic review aims to measuring prevalence and risk factors for antibiotic utilization in children in China. Methods English and Chinese databases were searched to identify relevant studies evaluating the prevalence and risk factors for antibiotic utilization in Chinese children (0-18 years), which were published between 2010 and July 2020. A Meta-analysis of prevalence was performed using random effect model. The Agency for Healthcare Research and Quality (AHRQ) and modified Jadad score was used to assess risk of bias of studies. In addition, we explored the risk factors of antibiotic utilization in Chinese children using qualitative analysis. Results Of 10,075 studies identified, 98 eligible studies were included after excluded duplicated studies. A total of 79 studies reported prevalence and 42 studies reported risk factors for antibiotic utilization in children. The overall prevalence of antibiotic utilization among outpatients and inpatients were 63.8% (35 studies, 95% confidence interval (CI): 55.1-72.4%), and 81.3% (41 studies, 95% CI: 77.3-85.2%), respectively. In addition, the overall prevalence of caregiver’s self-medicating of antibiotics for children at home was 37.8% (4 studies, 95% CI: 7.9-67.6%). The high prevalence of antibiotics was associated with multiple factors, while lacking of skills and knowledge in both physicians and caregivers was the most recognized risk factor, caregivers put pressure on physicians to get antibiotics and self-medicating with antibiotics at home for children also were the main factors attributed to this issue. Conclusion The prevalence of antibiotic utilization in Chinese children is heavy both in hospitals and home. It is important for government to develop more effective strategies to improve the irrational use of antibiotic, especially in rural setting.

Download Full-text

Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.695 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s168-s169

Author(s):

Rebecca Choudhury ◽

Ronald Beaulieu ◽

Thomas Talbot ◽

George Nelson

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Antibiotic Use ◽

Care Hospital ◽

Hospital Units ◽

Antibiotic Utilization ◽

Academic Medical ◽

Level Data ◽

Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

Download Full-text

Evaluation of Clinical Outcomes after Introduction of a Dedicated Infectious Diseases- Critical Care Medicine Service in Critical Care Units

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab182 ◽

2021 ◽

Author(s):

Polina Trachuk ◽

Vagish Hemmige ◽

Ruth Eisenberg ◽

Kelsie Cowman ◽

Victor Chen ◽

...

Keyword(s):

Critical Care ◽

Infectious Diseases ◽

Clinical Outcomes ◽

Broad Spectrum ◽

Critical Care Medicine ◽

Care Hospital ◽

Intervention Period ◽

Broad Spectrum Antibiotics ◽

Antibiotic Utilization ◽

The Impact

Abstract Objective Infection is a leading cause of admission to intensive care units (ICU), with critically ill patients often receiving empiric broad-spectrum antibiotics. Nevertheless, a dedicated infectious diseases (ID) consultation and stewardship team is not routinely established. An ID-Critical Care Medicine (ID-CCM) pilot program was designed at a 400-bed tertiary care hospital in which an ID attending was assigned to participate in daily rounds with the ICU team, as well as provide ID consultation on select patients. We sought to evaluate the impact of this dedicated ID program on antibiotic utilization and clinical outcomes in patients admitted to the ICU. Method In this single site retrospective study, we analyzed antibiotic utilization and clinical outcomes in patients admitted to an ICU during post-intervention period from January 1, 2017 to December 31, 2017 and compared it to antibiotic utilization in the same ICUs during the pre-intervention period from January 1, 2015 to December 31, 2015. Results Our data showed a statistically significant reduction in usage of most frequently prescribed antibiotics including vancomycin, piperacillin-tazobactam and cefepime during the intervention period. When compared to pre-intervention period there was no difference in-hospital mortality, hospital length of stay and re-admission. Conclusion With this multidisciplinary intervention, we saw a decrease in the use of the most frequently prescribed broad-spectrum antibiotics without a negative impact on clinical outcomes. Our study shows that the implementation of an ID-CCM service is a feasible way to promote antibiotic stewardship in the ICU and can be used as a strategy to reduce unnecessary patient exposure to broad-spectrum agents.

Download Full-text

Antibiotic utilization for adult acute respiratory tract infections in United States Emergency Departments

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.03.018 ◽

2021 ◽

Author(s):

Anastasia M. Schroeder ◽

Sarah S. Lewis ◽

Abe E. Sahmoun ◽

James R. Beal

Keyword(s):

United States ◽

Respiratory Tract ◽

Emergency Departments ◽

Respiratory Tract Infections ◽

Acute Respiratory Tract Infections ◽

Antibiotic Utilization ◽

Tract Infections

Download Full-text

Antibiotic utilization in open fractures

OTA International ◽

10.1097/oi9.0000000000000071 ◽

2020 ◽

Vol 3 (1) ◽

pp. e071

Author(s):

Yousif Atwan ◽

Theodore Miclau ◽

Emil H. Schemitsch ◽

David Teague

Keyword(s):

Open Fractures ◽

Antibiotic Utilization

Download Full-text

Hospital Standardized Mortality Ratio: Consequences of Adjusting Hospital Mortality with Indirect Standardization

PLoS ONE ◽

10.1371/journal.pone.0059160 ◽

2013 ◽

Vol 8 (4) ◽

pp. e59160 ◽

Cited By ~ 24

Author(s):

Maurice E. Pouw ◽

Linda M. Peelen ◽

Hester F. Lingsma ◽

Daniel Pieter ◽

Ewout Steyerberg ◽

...

Keyword(s):

Hospital Mortality ◽

Standardized Mortality Ratio ◽

Mortality Ratio ◽

Indirect Standardization

Download Full-text

A quality improvement project to reduce antibiotic utilization and ancillary laboratory tests in the appraisal of early-onset sepsis in the NICU

Journal of Pediatric Nursing ◽

10.1016/j.pedn.2021.06.012 ◽

2021 ◽

Vol 60 ◽

pp. 215-222

Author(s):

C. Martin Begnaud ◽

Jennifer Lemoine ◽

Lisa Broussard ◽

Roger Rholdon ◽

Harshit Doshi

Keyword(s):

Quality Improvement ◽

Early Onset ◽

Laboratory Tests ◽

Quality Improvement Project ◽

Improvement Project ◽

Antibiotic Utilization ◽

Early Onset Sepsis

Download Full-text

Abstract 005: A Comparison of Methods for Identifying Hospital Performance Outliers in Cardiac Surgery

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.005 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Xiaoting Wu ◽

Min Zhang ◽

Richard L Prager ◽

Donald S Likosky

Keyword(s):

Logistic Regression ◽

Regression Models ◽

Random Effect ◽

Hospital Performance ◽

Fixed Effect ◽

Logistic Regression Models ◽

Indirect Standardization ◽

Statistical Approaches ◽

Random Effect Models ◽

Direct Standardization

Introduction: A number of statistical approaches have been advocated and implemented to estimate adjusted hospital outcomes for public reporting or reimbursement. Nonetheless, the ability of these methods to identify hospital performance outliers in support of quality improvement has not yet been fully investigated. Methods: We leveraged data from patients undergoing coronary artery bypass grafting surgery between 2012-2015 at 33 hospitals participating in a statewide quality collaborative. We applied 5 different statistical approaches (1: indirect standardization with standard logistic regression models, 2: indirect standardization with fixed effect models, 3: indirect standardization with random effect models, 4: direct standardization with fixed effect models, 5: direct standardization with random effect models) to estimate hospital post-operative pneumonia rates adjusting for patients’ risk. Unlike the standard logistic regression models, both fixed effect and random effect models accounted for hospital effect. We applied each method to each year, and subsequently compared methods in their ability to identify hospital performance outliers. Results: Pneumonia rates ranged from 0 % to 24 %. The standard logistic regression models for 2013-2015 had c-statistics of 0.73-0.75, fixed effect models had c-statistics of 0.81-0.83, and random effect models had c-statistics of 0.80-0.83. Each method differed in its ability to identify performance outliers (Figure 1). In direct standardization, random effect models stabilized the hospital rates by moving the estimated rates toward the average rate, fixed effect models produced larger standard errors of hospital effect (particularly for hospitals with low case volumes). In indirect standardization, the three models showed high agreement on their derived observed: expected ratio (intraclass correlation =0.95). Indirect standardization with fixed effect or random effect models, identified similar hospital performance outliers in each year. Conclusion: The five statistical approaches varied in their ability to identify performance outliers. Given its higher sensitivity to outlier hospitals, indirect standardization methods with fixed or random effect models, may be best suited to support quality improvement activities.

Download Full-text

National Imaging and Antibiotic Practice Patterns in Children Presenting With Urinary Tract Infection to Community Practices: Little Impact From the American Academy of Pediatrics Guidelines?

Clinical Pediatrics ◽

10.1177/0009922819853003 ◽

2019 ◽

Vol 58 (11-12) ◽

pp. 1302-1308

Author(s):

Brian M. Inouye ◽

Zachary R. Dionise ◽

Ruiyang Jiang ◽

Steven Wolf ◽

Leigh Nicholl ◽

...

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Diagnostic Imaging ◽

American Academy ◽

Odds Ratio ◽

Practice Patterns ◽

American Academy Of Pediatrics ◽

Antibiotic Utilization ◽

Before And After

Our objective was to use community-based, national databases to evaluate diagnostic imaging and antibiotic prophylaxis practice patterns before and after the release of the 2011 American Academy of Pediatrics guidelines for acute febrile urinary tract infection. Using the National Ambulatory and Hospital Ambulatory Medical Care Surveys, urinary tract infection encounters were identified for patients aged 2 months to 18 years. Primary outcomes were utilization of antibiotics (as proxy for prophylaxis) and diagnostic imaging during encounters. Weighted multivariate logistic regression models were used to examine the association between time period (before and after 2011) and each of the primary outcomes. Among 8 588 035 weighted encounters, adjusting for covariates, there was insufficient evidence to suggest a difference between time periods for antibiotic utilization (odds ratio = 0.66, P = .12) or diagnostic imaging (odds ratio = 1.16, P = .56). Thus, we did not find evidence of changes in antibiotic utilization or diagnostic imaging practice patterns after the release of the 2011 American Academy of Pediatrics guidelines.

Download Full-text