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Indications and Types of Antibiotic Agents Used in 6 Acute Care Hospitals, 2009–2010: A Pragmatic Retrospective Observational Study

Published online by Cambridge University Press:  12 October 2015

Theodoros Kelesidis
Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
Nikolay Braykov
Center for Disease Dynamics, Economics & Policy, Washington, DC
Daniel Z. Uslan
Infectious Diseases, David Geffen School of Medicine/University of California, Los Angeles, Los Angeles, California
Daniel J. Morgan
Center for Disease Dynamics, Economics & Policy, Washington, DC Department of Epidemiology and Public Health, University of Maryland School of Medicine and Veterans Administration Maryland Healthcare System, Baltimore, Maryland
Sumanth Gandra
Center for Disease Dynamics, Economics & Policy, Washington, DC
Birgir Johannsson
Iowa City Veterans Administration Health Care System, Iowa City, Iowa
Marin L. Schweizer
Iowa City Veterans Administration Health Care System, Iowa City, Iowa
Scott A. Weisenberg
Alta Bates Summit Medical Center, Oakland, California
Heather Young
Denver Health Medical Center, Denver, Colorado
Joseph Cantey
Department of Pediatrics, University of Texas Southwestern, Dallas, Texas
Eli Perencevich
Iowa City Veterans Administration Health Care System, Iowa City, Iowa
Edward Septimus
Texas A&M Health Science Center College of Medicine, Houston, Texas Clinical Services Group, HCA Inc, Nashville, Tennessee
Arjun Srinivasan
Centers for Disease Control and Prevention, Atlanta, Georgia
Ramanan Laxminarayan*
Center for Disease Dynamics, Economics & Policy, Washington, DC Princeton Environmental Institute, Princeton University, Princeton, New Jersey Public Health Foundation of India, New Delhi, India
Address correspondence to Ramanan Laxminarayan, PhD, MPH, Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW Ste 500, Washington, DC 20005 (



To design better antimicrobial stewardship programs, detailed data on the primary drivers and patterns of antibiotic use are needed.


To characterize the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial stewardship programs.


Retrospective medical chart review was performed on a random cross-sectional sample of 1,200 adult inpatients, hospitalized (>24 hrs) in 6 hospitals, and receiving at least 1 antibiotic dose on 4 index dates chosen at equal intervals through a 1-year study period (October 1, 2009–September 30, 2010).


Infectious disease specialists recorded patient demographic characteristics, comorbidities, microbiological and radiological testing, and agents used, dose, duration, and indication for antibiotic prescriptions.


On the index dates 4,119 (60.5%) of 6,812 inpatients were receiving antibiotics. The random sample of 1,200 case patients was receiving 2,527 antibiotics (average: 2.1 per patient); 540 (21.4%) were prophylactic and 1,987 (78.6%) were therapeutic, of which 372 (18.7%) were pathogen-directed at start. Of the 1,615 empirical starts, 382 (23.7%) were subsequently pathogen-directed and 1,231 (76.2%) remained empirical. Use was primarily for respiratory (27.6% of prescriptions) followed by gastrointestinal (13.1%) infections. Fluoroquinolones, vancomycin, and antipseudomonal penicillins together accounted for 47.1% of therapy-days.


Use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities and in most instances was not subsequently pathogen directed. Fluoroquinolones, vancomycin, and antipseudomonal penicillins were the most frequently used antibiotics, particularly for respiratory indications.

Infect. Control Hosp. Epidemiol. 2015;37(1):70–79

Original Articles
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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