Stewardship in Community Hospitals Optimizing Outcomes and Resources (SCORE): A Baseline Analysis of Antimicrobial Use Utilizing CDC NHSN AU Data
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.
T. Greene, None
X. Sheng, None
P. Jones, None
R. Evans, None
W. R. Buckel, None
J. Burke, None
A. Pavia, None