scholarly journals 1960. Lost in Translation: Comparing Rates of Outpatient Antibiotic Use in Three Metrics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S62-S63
Author(s):  
Christopher Prestel ◽  
Laura M King ◽  
Monina Bartoces ◽  
Melinda M Neuhauser ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Negative Binomial ◽  
National Level ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
World Health ◽  
Oral Antibiotic ◽  
Defined Daily Doses ◽  
Days Of Therapy ◽  
Health Organization ◽  
Over Time

Abstract Background The Centers for Disease Control and Prevention (CDC) tracks US outpatient antibiotic use in prescriptions per 1000 persons (Rx/1000), while the World Health Organization uses defined daily doses per 1000 persons (DDD/1000), which are based on average adult dose, for global surveillance. A third metric, days of therapy (DOT)/1,000 persons, has not been previously evaluated at the national level. We aim to compare time trends in outpatient oral antibiotic use as Rx/1000, DDD/1000, and DOT/1,000 in the same data to inform ongoing CDC surveillance and facilitate international comparison. Methods We identified dispensed outpatient oral antibiotics using pharmacy claims in 2011–2016 IBM® MarketScan® Commercial Databases for individuals <65 years old. Using enrollment data, we calculated mean annual membership with drug coverage. Annual rates of outpatient oral antibiotic use were calculated for Rx/1000, DDD/1000, and DOT/1000 persons. Prescriptions written with a ratio of DDD to days supplied >10 were considered biologically implausible and excluded from DDD calculations. We examined trends for each metric from 2011 to 2016 using negative binomial regression. Results Annual numbers of outpatient oral antibiotic prescriptions ranged from 18.6 million to 30.0 million (mean 24.3 million). Overall, Rx/1000 decreased by 7% from 892 in 2011 to 829 in 2016 (Figure 1). From 2011 to 2016, DDD/1000 increased 2% from 23.8 to 24.2 while DOT/1000 decreased 9% from 25.4 to 23.1. Significant per-year decreases were found from 2011 to 2016 for Rx/1000 (−1.1%) and for DOT/1000 (−1.6%), while no significant per-year change was seen with DDD/1000 (table). DDD/1000 underestimate use in pediatrics under the age of 10 (Figure 2). Prolonged duration is seen in adolescents and reflected by DOT/1000. Conclusion Trends in DDD/1000 for population aged <65 years do not mirror trends in Rx/1000 and DOT/1000. These differences may reflect that Rx/1000 and DOT/1000 more accurately capture antibiotic prescriptions in children than DDD/1000. As DDD/1000 underestimate antibiotic use in children, DDD/1000 underestimates reduction in antibiotic use over time and may not accurately reflect changes in use over time. Disclosures All Authors: No reported Disclosures.

scholarly journals Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends

2019 ◽  
Author(s):  
Toby Bonvoisin ◽  
Leah Utyasheva ◽  
Duleeka Knipe ◽  
David Gunnell ◽  
Michael Eddleston
Keyword(s):  
Negative Binomial ◽  
Public Health Problem ◽  
State Level ◽  
Negative Binomial Regression ◽  
World Health ◽  
State Governments ◽  
Suicide Rates ◽  
Level Data ◽  
Agricultural Yield ◽  
Health Organization

Abstract Background Pesticide self-poisoning is a common means of suicide in India. Banning highly hazardous pesticides (HHPs) from agricultural use has been successful in reducing suicides in several Asian countries without affecting agricultural output. Here, we describe national and state-level regulation of HHPs and explore how they might relate to suicide rates across India.Methods Information on pesticide regulation was collated from agriculture departments of the central and state governments. National and state-level data on suicides from 1995 to 2015 were obtained from the National Crime Records Bureau (NCRB). We used joinpoint analysis and negative binomial regression to investigate any effects on trends in suicide rates nationally and in Kerala.Results As of October 2019, 318 pesticides were registered for use in India, of which 18 were extremely (Class Ia) or highly (Class Ib) hazardous according to World Health Organization criteria. Despite many HHPs still being available, several bans have been implemented during the period studied. In our quantitative analyses we focused on the permanent bans in Kerala in 2005 (of endosulfan) and 2011 (of 14 other pesticides); and nationally in 2011 (of endosulfan). NCRB data indicate that pesticides were used in 441,918 reported suicides in India from 1995-2015, 90.3% of which occurred in 11 of the 29 states. There was statistical evidence of lower than expected rates of pesticide suicides (rate ratio [RR] 0.52, 95% CI 0.49-0.54) and total suicides nationally by 2014 (0.90, 0.87-0.93) after the 2011 endosulfan ban. In Kerala, there was a lower than expected pesticide suicide rate (0.45, 0.42-0.49), but no change to the already decreasing trend in total suicides after the 2011 ban of 14 pesticides. The 2005 ban on endosulfan showed a similar effect. Agricultural outputs continued growing following the bans.Discussion Highly hazardous pesticides continue to be used in India and pesticide suicide remains a serious public health problem. However, some pesticide bans do appear to have impacted previous trends in the rates of both pesticide suicides and all suicides. Comprehensive national bans of HHPs could lead to a reduction in suicides across India, in addition to reduced occupational poisoning, with minimal effects on agricultural yield.

scholarly journals 2089. Effect of the Duke Antimicrobial Stewardship Outreach Network (DASON): A Multi-Center Time Series Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S705-S706
Author(s):  
Michael E Yarrington ◽  
Elizabeth Dodds Ashley ◽  
Melissa D Johnson ◽  
Angelina Davis ◽  
April Dyer ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Negative Binomial ◽  
Statistical Significance ◽  
Cohort Analysis ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
First Year ◽  
Hospital Data ◽  
Hospital Size ◽  
Days Of Therapy

Abstract Background DASON is a 30-member, community hospital network in the southeastern United States that supports the development and growth of local antibiotic stewardship programs (ASPs). Collaborative activities include on-site visits from liaison clinical pharmacists, data sharing for routine feedback and benchmarking, and educational programs. Methods We performed a retrospective cohort analysis of antibiotic use (AU) in 17 hospitals that participated in DASON for a minimum of 42 months during 2013–2018. Segmented negative binomial regression models were used to estimate the change in facility-wide AU after an initial 1-year assessment, planning, and ASP intervention initiation period. Baseline AU trend (1 to 12 months) was compared against AU following the first year (13 to 42 months). Monthly AU rates were measured in days of therapy (DOT) per 1,000 patient-days (pd). Models assessed overall AU and specific antibiotic groups, as defined by the National Healthcare Safety Network AU option. The models controlled for hospital size, presence of a pre-existing formal ASP upon network entry, and year of network entry. Results Hospital data included a total of 2,988,930 pd over 5 years. Facility-wide AU was increasing during the first year of network entry and then began decreasing by 0.2% per month (P = 0.01, figure). Fluoroquinolone use was stagnant in year one and then decreased by 1.5% per month (P ≤ 0.001, figure). Antifungal agents were decreasing in year one and continued to decrease 0.7% per month thereafter (P = 0.03, figure). Agents predominantly used for resistant Gram-positive infections and broad-spectrum agents used for hospital-onset infections were increasing during year one and then attenuated afterward, though the slope change did not reach statistical significance. The presence of a pre-existing formal ASP was not a significant covariate in any model, while bed size and year of network entry significantly contributed to models of some antibiotic groups. Conclusion Participation in DASON was associated with a decline in total AU and fluoroquinolone use, and a trend toward attenuated use of other broad-spectrum agents in community hospitals. Collaborative network experiences can help local ASPs achieve reductions in AU. Disclosures All authors: No reported disclosures.

scholarly journals Use of Antibiotics among Residents Living Close to Poultry or Goat Farms: A Nationwide Analysis in The Netherlands

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1346
Author(s):  
Inge Roof ◽  
Wim van der Hoek ◽  
Lisette Oude Boerrigter ◽  
Cornelia C. H. Wielders ◽  
Lidwien A. M. Smit
Keyword(s):  
The Netherlands ◽  
Negative Binomial ◽  
Economic Status ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Postal Code ◽  
Prescription Data ◽  
Livestock Farming ◽  
Defined Daily Doses ◽  
Goat Farm

Prior regional studies found a high risk of pneumonia for people living close to poultry and goat farms. This epidemiological study in the Netherlands used nationwide antibiotic prescription data as a proxy for pneumonia incidence to investigate whether residents of areas with poultry and goat farms use relatively more antibiotics compared to areas without such farms. We used prescription data on antibiotics most commonly prescribed to treat pneumonia in adults and livestock farming data, both with nationwide coverage. Antibiotic use was expressed as defined daily doses per (4-digit Postal Code (PC4) area)-(age group)-(gender)-(month) combination for the year 2015. We assessed the associations between antibiotic use and farm exposure using negative binomial regression. The amoxicillin, doxycycline, and co-amoxiclav use was significantly higher (5–10% difference in use) in PC4 areas with poultry farms present compared to areas without, even after adjusting for age, gender, smoking, socio-economic status, and goat farm presence. The adjusted models showed no associations between antibiotic use and goat farm presence. The variables included in this study could only partly explain the observed regional differences in antibiotic use. This was an ecological study that precludes inference about causal relations. Further research using individual-level data is recommended.

scholarly journals Regulation of highly hazardous pesticides in India - implications for suicide prevention

2019 ◽  
Author(s):  
Toby Bonvoisin ◽  
Leah Utyasheva ◽  
Duleeka Knipe ◽  
David Gunnell ◽  
Michael Eddleston
Keyword(s):  
Negative Binomial ◽  
Public Health Problem ◽  
State Level ◽  
Negative Binomial Regression ◽  
World Health ◽  
State Governments ◽  
Suicide Rates ◽  
Level Data ◽  
Agricultural Yield ◽  
Health Organization

Abstract Background: Pesticide self-poisoning is a common means of suicide in India. Banning highly hazardous pesticides from agricultural use has been successful in reducing total suicide numbers in several South Asian countries without affecting agricultural output. Here, we describe national and state-level regulation of highly hazardous pesticides and relate them to suicide rates across India. Methods: Information on pesticide regulation was collated from agriculture departments of central and state governments. National and state-level data on suicides for 1995 until 2015 was obtained from the National Crime Records Bureau (NCRB). We used joinpoint analysis and negative binomial regression to investigate the possible effects of pesticide bans on trends in suicide rates. Results: As of August 2019, 314 pesticides were registered for use in India, of which 18 were extremely (Class Ia) or highly (Class Ib) hazardous according to World Health Organization toxicity criteria. Despite many highly hazardous pesticides still being available, a number of bans have been implemented during the period studied. In our quantitative analyses we focussed on the permanent bans in Kerala in 2005 (of endosulfan) and 2011 (of 14 other pesticides); and nationally in 2011 (of endosulfan). NCRB data indicate that pesticides were used in 441,918 reported suicides in India from 1995-2015, 90.3% of which occurred in 11 of the 29 states. Time series analysis demonstrated statistical evidence of lower than expected rates of pesticide suicides and total suicides nationally after the 2011 endosulfan ban. In Kerala, there was a lower than expected rate of pesticide suicides but no change to the already decreasing trend in total suicides after both the 2005 ban of endosulfan and the 2011 ban of 14 pesticides. Discussion: Highly hazardous pesticides continue to be used in India, and pesticide suicide remains a serious public health problem. However, some bans of pesticides do appear to have impacted previous trends in the rates of both pesticide suicides and all suicides. Comprehensive national bans of highly hazardous pesticides could lead to a reduction in suicides across India, in addition to reduced occupational poisoning, with minimal effects on agricultural yield.

scholarly journals Significant Regional Differences in Antibiotic Use Across 576 US Hospitals and 11 701 326 Adult Admissions, 2016–2017

2020 ◽  
Author(s):  
Katherine E Goodman ◽  
Sara E Cosgrove ◽  
Lisa Pineles ◽  
Laurence S Magder ◽  
Deverick J Anderson ◽  
...  
Keyword(s):  
Regional Differences ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Fourth Generation ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Healthcare Database ◽  
Days Of Therapy ◽  
Adult Inpatient

Abstract Background Quantifying the amount and diversity of antibiotic use in United States hospitals assists antibiotic stewardship efforts but is hampered by limited national surveillance. Our study aimed to address this knowledge gap by examining adult antibiotic use across 576 hospitals and nearly 12 million encounters in 2016–2017. Methods We conducted a retrospective study of patients aged ≥ 18 years discharged from hospitals in the Premier Healthcare Database between 1 January 2016 and 31 December 2017. Using daily antibiotic charge data, we mapped antibiotics to mutually exclusive classes and to spectrum of activity categories. We evaluated relationships between facility and case-mix characteristics and antibiotic use in negative binomial regression models. Results The study included 11 701 326 admissions, totaling 64 064 632 patient-days, across 576 hospitals. Overall, patients received antibiotics in 65% of hospitalizations, at a crude rate of 870 days of therapy (DOT) per 1000 patient-days. By class, use was highest among β-lactam/β-lactamase inhibitor combinations, third- and fourth-generation cephalosporins, and glycopeptides. Teaching hospitals averaged lower rates of total antibiotic use than nonteaching hospitals (834 vs 957 DOT per 1000 patient-days; P &lt; .001). In adjusted models, teaching hospitals remained associated with lower use of third- and fourth-generation cephalosporins and antipseudomonal agents (adjusted incidence rate ratio [95% confidence interval], 0.92 [.86–.97] and 0.91 [.85–.98], respectively). Significant regional differences in total and class-specific antibiotic use also persisted in adjusted models. Conclusions Adult inpatient antibiotic use remains high, driven predominantly by broad-spectrum agents. Better understanding reasons for interhospital usage differences, including by region and teaching status, may inform efforts to reduce inappropriate antibiotic prescribing.

scholarly journals Decreasing Trends in Antibiotic Consumption in Public Hospitals from 2014 to 2017 Following the Decentralization of Drug Procurement in Myanmar

2021 ◽  
Vol 6 (2) ◽  
pp. 57
Author(s):  
Khin Hnin Pwint ◽  
Kyaw Soe Min ◽  
Wenjing Tao ◽  
Hemant Deepak Shewade ◽  
Khin Thet Wai ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Consumption ◽  
Public Hospitals ◽  
World Health ◽  
Beta Lactam ◽  
Drug Procurement ◽  
Pull System ◽  
Defined Daily Doses ◽  
Health Organization ◽  
Over Time

(1) Background: In 2014, drug procurement for public hospitals in Myanmar was decentralized to a pull system. This might lead to increasing trends in the consumption of broad-spectrum and last-resort antibiotics. For fiscal years 2014-2017, we assessed annual antibiotic consumption trends and patterns in total defined daily doses (DDDs). (2) Methods: We followed World Health Organization (WHO) methodology for surveillance of antimicrobial consumption based on hospital antibiotic procurement records (as a proxy). (3) Results: In 32% of all public hospitals where data were retrieved, total antibiotic consumption reduced by 19% between 2014 (7,122,852 DDD) and 2017 (5,794,904 DDD). Consumption per 1000 inhabitants per day (<200 bed hospitals) also reduced from 0.6 to 0.3. Over 60% of procurement was for beta-lactam antibiotics and quinolones; quinolones decreased over time. Consumption of first-line antibiotics increased (42% in 2014 to 54% in 2017), whereas broad-spectrum antibiotics decreased (46% in 2014 to 38% in 2017). Linezolid was the only last-resort antibiotic procured. There was a progressive reduction in per capita government current health expenditure from approximately 9.2 US$ in 2014 to 8.3 US$ in 2017. (4) Conclusions: Antibiotic consumption decreased over time in public hospitals. This first study provides a baseline for developing an antibiotic consumption surveillance system in Myanmar.

scholarly journals Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

2020 ◽  
Author(s):  
Daniel J Livorsi ◽  
Rajeshwari Nair ◽  
Brian C Lund ◽  
Bruce Alexander ◽  
Brice F Beck ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antibiotic Stewardship ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Negative Binomial Regression Model ◽  
Veterans Health ◽  
Health Administration ◽  
Patient Admissions ◽  
Days Of Therapy

Abstract Background Many US hospitals lack infectious disease (ID) specialists, which may hinder antibiotic stewardship efforts. We sought to compare patient-level antibiotic exposure at Veterans Health Administration (VHA) hospitals with and without an on-site ID specialist, defined as an ID physician and/or ID pharmacist. Methods This retrospective VHA cohort included all acute-care patient admissions during 2016. A mandatory survey was used to identify hospitals’ antibiotic stewardship processes and their access to an on-site ID specialist. Antibiotic use was quantified as days of therapy per days present and categorized based on National Healthcare Safety Network definitions. A negative binomial regression model with risk adjustment was used to determine the association between presence of an on-site ID specialist and antibiotic use at the level of patient admissions. Results Eighteen of 122 (14.8%) hospitals lacked an on-site ID specialist; there were 525 451 (95.8%) admissions at ID hospitals and 23 007 (4.2%) at non-ID sites. In the adjusted analysis, presence of an ID specialist was associated with lower total inpatient antibacterial use (odds ratio, 0.92; 95% confidence interval, .85–.99). Presence of an ID specialist was also associated with lower use of broad-spectrum antibacterials (0.61; .54–.70) and higher narrow-spectrum β-lactam use (1.43; 1.22–1.67). Total antibacterial exposure (inpatient plus postdischarge) was lower among patients at ID versus non-ID sites (0.92; .86–.99). Conclusions Patients at hospitals with an ID specialist received antibiotics in a way more consistent with stewardship principles. The presence of an ID specialist may be important to effective antibiotic stewardship.

scholarly journals Comparative study of use of prophylactic antibiotic for elective hernia repair with use of prosthetic material: observational study in a tertiary care institute

2017 ◽  
Vol 4 (11) ◽  
pp. 3732
Author(s):  
Philip Umman ◽  
Joyal Jose ◽  
Althaf Ahmed ◽  
Jeenu Xavier
Keyword(s):  
Hernia Repair ◽  
Wound Infection ◽  
Tertiary Care ◽  
Prophylactic Antibiotic ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
World Health ◽  
Prosthetic Material ◽  
Oral Antibiotic ◽  
Health Organization

Background: There is widespread misuse of antibiotics leading to increasing reports of drug resistance. This has been highlighted by the World Health Organization (WHO). Wrong antibiotics are chosen, used when not indicated and used in dosages or patterns that are not recommended. We tried to analyse the pattern of antibiotic use for elective hernia repair using polypropylene mesh among the surgical units in our hospital for elective clean cases. The antibiotic use pattern and the incidence of surgical site infections were to be analysed to create uniform policies for antibiotic use across the institution.Methods: We looked at the case records of patients undergoing elective hernia repair in one month in our institution under different surgeons. Inguinal, umbilical and simple incisional hernias were taken into study. Both open and laparoscopic hernia repairs were included in the study. Emergency hernia repairs were excluded. We looked at the type of prophylactic antibiotic given, the dose and approximate time difference between injection and incision time, whether patient received further doses of intravenous or oral antibiotic. If further doses were given, we also looked for reasons if documented. These cases were followed for one month to see if there was any difference in the incidence of surgical site infections.Results: There were thirty-one cases, of which 16 received only a single dose of prophylactic antibiotic while 15 received more than one dose of antibiotic. Only one patient in the prophylactic antibiotic only group developed a culture positive wound infection. There was seroma formation in two patients.Conclusions: There was no evidence of higher incidence of wound infection in patients receiving only prophylactic antibiotic. There is a need for developing institution specific policies on antibiotic use. This will reduce the treatment costs and also avoid the development of antibiotic resistance in the society.

scholarly journals The impact of surveillance and other factors on detection of emergent and circulating vaccine derived polioviruses

2021 ◽  
Vol 5 ◽  
pp. 94
Author(s):  
Megan Auzenbergs ◽  
Holly Fountain ◽  
Grace Macklin ◽  
Hil Lyons ◽  
Kathleen M O'Reilly
Keyword(s):  
Negative Binomial ◽  
Oral Polio Vaccine ◽  
Negative Binomial Regression ◽  
Polio Eradication ◽  
Outbreak Detection ◽  
World Health ◽  
Negative Binomial Regression Model ◽  
Uncertainty Interval ◽  
Health Organization ◽  
The Impact

Background: Circulating vaccine derived poliovirus (cVDPV) outbreaks remain a threat to polio eradication. To reduce cases of polio from cVDPV of serotype 2, the serotype 2 component of the vaccine has been removed from the global vaccine supply, but outbreaks of cVDPV2 have continued. The objective of this work is to understand the factors associated with later detection in order to improve detection of these unwanted events. Methods: The number of nucleotide differences between each cVDPV outbreak and the oral polio vaccine (OPV) strain was used to approximate the time from emergence to detection. Only independent emergences were included in the analysis. Variables such as serotype, surveillance quality, and World Health Organization (WHO) region were tested in a negative binomial regression model to ascertain whether these variables were associated with higher nucleotide differences upon detection. Results: In total, 74 outbreaks were analysed from 24 countries between 2004 and 2019. For serotype 1 (n=10), the median time from seeding until outbreak detection was 284 (95% uncertainty interval (UI) 284-2008) days, for serotype 2 (n=59), 276 (95% UI 172-765) days, and for serotype 3 (n=5), 472 (95% UI 392-603) days. Significant improvement in the time to detection was found with increasing surveillance of non-polio acute flaccid paralysis (AFP) and adequate stool collection. Conclusions: cVDPVs remain a risk globally; all WHO regions have reported at least one VDPV outbreak since the first outbreak in 2001. Maintaining surveillance for poliomyelitis after local elimination is essential to quickly respond to both emergence of VDPVs and potential importations. Considerable variation in the time between emergence and detection of VDPVs were apparent, and other than surveillance quality and inclusion of environmental surveillance, the reasons for this remain unclear.

scholarly journals 21. Association of MRSA Prevalence and Hospital-level Antibiotic Use: A Retrospective Study Across 122 Acute-care Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S11-S11
Author(s):  
Daniel J Livorsi ◽  
Rajeshwari Nair ◽  
Brian Lund ◽  
Bruce Alexander ◽  
Brice Beck ◽  
...  
Keyword(s):  
Acute Care ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Antibiotic Use ◽  
Case Mix ◽  
Veterans Health ◽  
Health Administration ◽  
Hospital Level ◽  
Days Of Therapy ◽  
Research Grant

Abstract Background The prevalence of methicillin-resistant Staphylococcus aureus (MRSA), varies across geographic regions, which could contribute to regional variation in antibiotic use. In this study, we evaluated whether local MRSA prevalence rates were associated with hospital-level antibiotic use across the Veterans Health Administration (VHA). Methods This retrospective cohort included all acute-care patients admitted in VHA hospitals during 2016. Anti-MRSA antibiotics were identified per National Healthcare Safety Network definitions and use was quantified as days-of-therapy (DOT) per 1000 days-present. Hospital-level MRSA prevalence (colonization and/or infection) was determined by calculating the proportion of admissions with a positive MRSA nasal swab and/or a MRSA-positive clinical culture obtained ≤1 day before or ≤2 days after admission. Negative binomial regression models were used to determine the association between a hospital’s MRSA prevalence and its antibiotic use, after accounting for intra-hospital clustering, patient case-mix, month of admission, and use of hospital-based stewardship strategies. Results There were 548,476 admissions across 122 hospitals. The median rate of MRSA prevalence at admission was 8.0% (IQR 6.7–9.7%). Hospital level median use of anti-MRSA and total antibiotics was 96.5 (interquartile range [IQR] 81.1–116.9) and 562.1 (IQR 505.9–631.6) DOT per 1,000 days-present, respectively. In a hospital-level risk adjusted analysis, a hospital’s MRSA prevalance was significantly associated with its monthly use of both anti-MRSA and total antibiotics (IRR=1.05, 95% 1.02–1.07; IRR=1.02, 95% CI, 1.01–1.03). A 5% increase in the hospital’s MRSA prevalence was associated with an increase in the monthly use of anti-MRSA antibiotics and total antibiotics by 23.6 and 8.3 DOT per 1,000 days-present, respectively. Conclusion Higher hospital-level MRSA prevalence was associated with significantly higher rates of antibiotic utilization, even after adjusting for case-mix and reported antibiotic stewardship strategies. Future benchmarking of anti-MRSA antibiotic use across hospitals may need to risk-adjust using baseline rates of MRSA prevalence. Disclosures Daniel J. Livorsi, MD, MSc, Merck and Company, Inc (Research Grant or Support) Rajeshwari Nair, PhD, Merck and Company, Inc. (Research Grant or Support)

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