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Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

Published online by Cambridge University Press:  12 June 2018

Bradley J. Langford
Affiliation:
Public Health Ontario, Toronto, Canada St Joseph’s Health Center, Toronto, Canada
Julie Hui-Chih Wu
Affiliation:
Public Health Ontario, Toronto, Canada
Kevin A. Brown
Affiliation:
Public Health Ontario, Toronto, Canada University of Toronto, Toronto, Canada
Xuesong Wang
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Canada
Valerie Leung
Affiliation:
Public Health Ontario, Toronto, Canada
Charlie Tan
Affiliation:
London Health Sciences Center, London, Canada
Gary Garber
Affiliation:
Public Health Ontario, Toronto, Canada University of Toronto, Toronto, Canada University of Ottawa, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada
Nick Daneman
Affiliation:
Public Health Ontario, Toronto, Canada University of Toronto, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada Division of Infectious Diseases, Sunnybrook Health Sciences Center, Toronto, Canada Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Canada
Corresponding
E-mail address:

Abstract

Objectives

Antibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.

Design

Observational study of acute-care hospitals in Ontario, Canada

Methods

A survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.

Results

Of 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.

Conclusions

Wide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

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