Skip to main content
    • Aa
    • Aa

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

  • Theodoros Kelesidis (a1), Nikolay Braykov (a2), Daniel Z. Uslan (a1), Daniel J. Morgan (a2) (a3), Sumanth Gandra (a2), Birgir Johannsson (a4), Marin L. Schweizer (a4), Scott A. Weisenberg (a5), Heather Young (a6), Joseph Cantey (a7), Eli Perencevich (a4), Edward Septimus (a8) (a9), Arjun Srinivasan (a10) and Ramanan Laxminarayan (a2) (a11) (a12)...

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

Corresponding author
Address correspondence to Ramanan Laxminarayan, PhD, MPH, Center for Disease Dynamics, Economics & Policy, 1400 Eye St NW Ste 500, Washington, DC 20005 (
Hide All
3. BA Lipsky , GJ Moran , LM Napolitano , L Vo , S Nicholson , M Kim . A prospective, multicenter, observational study of complicated skin and soft tissue infections in hospitalized patients: clinical characteristics, medical treatment, and outcomes. BMC Infect Dis 2012;12:227.

6. F Ansari , M Erntell , H Goossens , P Davey . The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis 2009;49:14961504.

9. RE Polk , SF Hohmann , S Medvedev , O Ibrahim . Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infect Dis 2011;53:11001110.

10. SS Magill , JR Edwards , ZG Beldavs , et al. Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. JAMA 2014;312:14381446.

11. P Malacarne , C Rossi , G Bertolini . Antibiotic usage in intensive care units: a pharmaco-epidemiological multicentre study. J Antimicrob Chemother 2004;54:221224.

12. J Mettler , M Simcock , P Sendi , et al. Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study. BMC Infect Dis 2007;7:21.

13. P Montravers , H Dupont , R Gauzit , B Veber , JP Bedos , A Lepape . Strategies of initiation and streamlining of antibiotic therapy in 41 French intensive care units. Crit Care 2011;15:R17.

15. A Cusini , SK Rampini , V Bansal , et al. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey. PLoS One 2010;5:e14011.

17. MT Hecker , DC Aron , NP Patel , MK Lehmann , CJ Donskey . Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Arch Intern Med 2003;163:972978.

18. MH Kollef , LE Morrow , MS Niederman , et al. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest 2006;129:12101218.

19. J Robert , Y Pean , E Varon , et al. Point prevalence survey of antibiotic use in French hospitals in 2009. J Antimicrob Chemother 2012;67:10201026.

20. ED Chun , PE Rodgers , CA Vitale , CD Collins , PN Malani . Antimicrobial use among patients receiving palliative care consultation. Am J Hosp Palliat Care 2010;27:261265.

23. MD Zilberberg , AF Shorr , ST Micek , SH Mody , MH Kollef . Antimicrobial therapy escalation and hospital mortality among patients with health-care-associated pneumonia: a single-center experience. Chest 2008;134:963968.

25. NP Braykov , DJ Morgan , ML Schweizer , et al. Assessment of empirical antibiotic therapy optimisation in six hospitals: an observational cohort study. Lancet Infect Dis 2014;14:12201227.

26. PA Harris , R Taylor , R Thielke , J Payne , N Gonzalez , JG Conde . Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377381.

34. CA Ohl , VP Luther . Antimicrobial stewardship for inpatient facilities. J Hosp Med 2011;6:S415.

38. AM Huang , D Newton , A Kunapuli , et al. Impact of rapid organism identification via matrix-assisted laser desorption/ionization time-of-flight combined with antimicrobial stewardship team intervention in adult patients with bacteremia and candidemia. Clin Infect Dis 2013;57:12371245.

39. DL Paterson . “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 2004;38:S341S345.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
Type Description Title
Supplementary Materials

Kelesidis supplementary material
Figure 1 and Table 1-2

 Word (85 KB)
85 KB


Full text views

Total number of HTML views: 7
Total number of PDF views: 62 *
Loading metrics...

Abstract views

Total abstract views: 387 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 26th September 2017. This data will be updated every 24 hours.