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Antimicrobial Use in Outpatient Hemodialysis Units

Published online by Cambridge University Press:  02 January 2015

Graham M. Snyder ,
Priti R. Patel ,
Alexander J. Kallen ,
James A. Strom ,
J. Kevin Tucker  and
Erika M. C. D'Agata
Graham M. Snyder*
Affiliation:
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Priti R. Patel
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
Alexander J. Kallen
Affiliation:
Centers for Disease Control and Prevention, Atlanta, Georgia
James A. Strom
Affiliation:
St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts
J. Kevin Tucker
Affiliation:
Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Erika M. C. D'Agata
Affiliation:
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
*
Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 330 Brookline Avenue, Mailstop SL-435, Boston, MA 02215 (gsnyder@bidmc.harvard.edu)
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Abstract

Objective.

To quantify and characterize overall antimicrobial use, including appropriateness of indication, among patients receiving chronic hemodialysis.

Design.

Retrospective and prospective observational study.

Setting.

Two outpatient hemodialysis units.

Patients.

All patients receiving chronic hemodialysis.

Methods.

The rate of parenteral antimicrobial use (number of doses per 100 patient-months) was calculated retrospectively from September 2008 through July 2011. Indication and appropriateness of antimicrobial doses were characterized prospectively from August 2010 through July 2011. Inappropriate administration was defined as occasions when criteria for infection based on national guidelines were not met, failure to choose a more narrow-spectrum antimicrobial on the basis of culture data, or occasions when indications for surgical prophylaxis were not met.

Results.

Over the 35-month retrospective study period, the rate of parenteral antimicrobial use was 32.9 doses per 100 patient-months. Vancomycin was the most commonly prescribed antimicrobial, followed by cefazolin and third- or fourth-generation cephalosporins. Over the 12-month prospective study, 1,003 antimicrobial doses were prescribed. Among the 926 (92.3%) doses for which an indication for administration was available, 276 (29.8%) were classified as inappropriate. Of these, a total of 146 (52.9%) did not meet criteria for infection, 74 (26.8%) represented failure to choose a more narrow-spectrum antimicrobial, and 56 (20.3%) did not meet criteria for surgical prophylaxis. The most common inappropriately prescribed antimicrobials were vancomycin and third- or fourth- generation cephalosporins.

Conclusions.

Parenteral antimicrobial use was extensive, and as much as one-third was categorized as inappropriate. The findings of this study provide novel information toward minimizing inappropriate antimicrobial use.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 4 , April 2013 , pp. 349 - 357
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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