Charlie Tan1, Marian Vermeulen2, Xuesong Wang2, Rosemary Zvonar3, Gary Garber3, Nick Daneman4,2,5. 1. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 3. Infection Prevention and Control, Public Health Ontario, Ontario, Canada. 4. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada nick.daneman@sunnybrook.ca. 5. Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Antibiotic stewardship is a required organizational practice for Canadian acute care hospitals, yet data are scarce regarding the quantity and composition of antibiotic use across facilities. We sought to examine the variability, and risk-adjusted variability, in antibiotic use across acute care hospitals in Ontario, Canada's most populous province. METHODS: Antibiotic purchasing data from IMS Health, previously demonstrated to correlate strongly with internal antibiotic dispensing data, were acquired for 129 Ontario hospitals from January to December 2014 and linked to patient day (PD) denominator data from administrative datasets. Hospital variation in DDDs/1000 PDs was determined for overall antibiotic use, class-specific use and six practices of clinical or ecological significance. Multivariable risk adjustment for hospital and patient characteristics was used to compare observed versus expected utilization. RESULTS: There was 7.4-fold variability in the quantity of antibiotic use across the 129 acute care hospitals, from 253 to 1873 DDDs/1000 PDs. Variation was evident within hospital subtypes, exceeded that explained by hospital and patient characteristics, and included wide variability in proportion of broad-spectrum antibiotics (IQR 36%-48%), proportion of fluoroquinolones among respiratory antibiotics (IQR 40%-62%), proportion of ciprofloxacin among urinary anti-infectives (IQR 44%-60%), proportion of antibiotics with highest risk for Clostridium difficile (IQR 29%-40%), proportion of 'reserved-use' antibiotics (IQR 0.8%-3.5%) and proportion of anti-pseudomonal antibiotics among antibiotics with Gram-negative coverage (IQR 26%-40%). CONCLUSIONS: There is extensive variability in antibiotic use, and risk-adjusted use, across acute care hospitals. This could motivate, focus and benchmark antibiotic stewardship efforts.
BACKGROUND: Antibiotic stewardship is a required organizational practice for Canadian acute care hospitals, yet data are scarce regarding the quantity and composition of antibiotic use across facilities. We sought to examine the variability, and risk-adjusted variability, in antibiotic use across acute care hospitals in Ontario, Canada's most populous province. METHODS: Antibiotic purchasing data from IMS Health, previously demonstrated to correlate strongly with internal antibiotic dispensing data, were acquired for 129 Ontario hospitals from January to December 2014 and linked to patient day (PD) denominator data from administrative datasets. Hospital variation in DDDs/1000 PDs was determined for overall antibiotic use, class-specific use and six practices of clinical or ecological significance. Multivariable risk adjustment for hospital and patient characteristics was used to compare observed versus expected utilization. RESULTS: There was 7.4-fold variability in the quantity of antibiotic use across the 129 acute care hospitals, from 253 to 1873 DDDs/1000 PDs. Variation was evident within hospital subtypes, exceeded that explained by hospital and patient characteristics, and included wide variability in proportion of broad-spectrum antibiotics (IQR 36%-48%), proportion of fluoroquinolones among respiratory antibiotics (IQR 40%-62%), proportion of ciprofloxacin among urinary anti-infectives (IQR 44%-60%), proportion of antibiotics with highest risk for Clostridium difficile (IQR 29%-40%), proportion of 'reserved-use' antibiotics (IQR 0.8%-3.5%) and proportion of anti-pseudomonal antibiotics among antibiotics with Gram-negative coverage (IQR 26%-40%). CONCLUSIONS: There is extensive variability in antibiotic use, and risk-adjusted use, across acute care hospitals. This could motivate, focus and benchmark antibiotic stewardship efforts.
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Authors: Wallis Rudnick; Michelle Science; Daniel J G Thirion; Kahina Abdesselam; Kelly B Choi; Linda Pelude; Kanchana Amaratunga; Jeannette L Comeau; Bruce Dalton; Johan Delport; Rita Dhami; Joanne Embree; Yannick Émond; Gerald Evans; Charles Frenette; Susan Fryters; Greg German; Jennifer M Grant; Jennifer Happe; Kevin Katz; Pamela Kibsey; Justin Kosar; Joanne M Langley; Bonita E Lee; Marie-Astrid Lefebvre; Jerome A Leis; Allison McGeer; Heather L Neville; Andrew Simor; Kathryn Slayter; Kathryn N Suh; Alena Tse-Chang; Karl Weiss; John Conly Journal: Antimicrob Resist Infect Control Date: 2020-02-13 Impact factor: 4.887
Authors: Rebekah W Moehring; Matthew Phelan; Eric Lofgren; Alicia Nelson; Elizabeth Dodds Ashley; Deverick J Anderson; Benjamin A Goldstein Journal: JAMA Netw Open Date: 2021-03-01