Program Schedule

Stewardship in Community Hospitals – Optimizing Outcomes and Resources (SCORE): A Baseline Analysis of Antimicrobial Use Utilizing CDC NHSN AU Data

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background:   The SCORE study is a cluster randomized trial of antimicrobial stewardship interventions at 15 small community hospitals (SCHs, bed range: 8 – 126).  Antimicrobial use in SCHs is poorly described.  As a pre-intervention baseline analysis we analyzed variability in antimicrobial use in SCHs and sought to identify candidate variables to facilitate case-mix adjustment for interhospital comparison using NHSN data . 

Methods:    Intermountain Healthcare includes 15 SCHs that report to the NHSN Antimicrobial Use option, a validated approach for antimicrobial use measurement.  Use was reported in days of antibiotic therapy (DOT) /1000 pt days (PD) monthly from 2011-13.  Floors were categorized as:  1) ICU, 2) medical/surgical, 3) pediatrics, and 4) other (e.g. labor/delivery).  An average 3 year rate of antimicrobial use was calculated for floor type and facility.  95% CI were calculated assuming a Poisson distribution.  A mixed effect Poisson regression model with a random hospital effect was fitted to characterize variation in antimicrobial use among facilities and floor types.

Results:  Total antimicrobial utilization varied widely across the 15 SCHs (range: 134- 671 DOT/1000 PD, coefficient of variation [CV] = 36%), Figure 1.  Examination of antimicrobial use within floor types revealed significant differences in antimicrobial use, table 1.  ICUs had the highest use of antimicrobials with a mean of 893 DOT/1000PD (range: 782 – 1158) but the lowest CV (16%) in mixed effects analysis.  “Other” floors had lowest use with a mean of 74 DOT/1000PD (range: 13 – 167) but the largest CV = 72%.  Mean use in medical/surgical floors w 627 DOT/1000 PD (range: 147 – 790, CV=43%). Mean use in pediatric floors was 503 DOT/1000PD (range 401 – 586, CV = 19%). 

Conclusion:  There is substantial variation total antimicrobial use across SCHs.  Total use is dependent, in part, on the case-mix of patients served in each facility and floor type is a promising variable for adjustment to be used for interhospital benchmarking.  Nonetheless, variability in use remains substantial within floor types and is a potential target for stewardship opportunities. 

Edward Stenehjem, MD MSc1, Adam L. Hersh, MD, PhD2, Tom Greene, PhD3, Xiaoming Sheng, PhD3, Peter Jones, MSLS4, R Evans, PhD5, Whitney R. Buckel, PharmD6, John Burke, MD1 and Andrew Pavia, MD, FIDSA, FSHEA2, (1)Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, UT, (2)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (3)Medicine, University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT, (4)Department of Clinical Epidemiology and Infectious Diseases, Intermountain Medical Center, Murray, UT, (5)Intermountain Healthcare, Salt Lake City, UT, (6)Intermountain Medical Center, Murray, UT


E. Stenehjem, None

A. L. Hersh, None

T. Greene, None

X. Sheng, None

P. Jones, None

R. Evans, None

W. R. Buckel, None

J. Burke, None

A. Pavia, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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