Factors Associated With Inappropriate Antibiotic Use in Hospitalized Patients

Abstract

Background: Inappropriate antibiotic prescription leads to increased Clostridiodes difficile infections, adverse effects including organ toxicity, and generation of antibiotic-resistant bacteria. Despite efforts to improve antibiotic use in acute-care settings, unnecessary and inappropriate prescription still occur in 30%–50% of patients. Objectives: We assessed factors associated with inappropriate antibiotic prescription at 2 time points: (1) initial, empiric therapy and (2) 3–5 days after therapy initiation. Methods: As part of a multicenter study investigating strategies to reduce antibiotic therapy after 3–5 days of use, antibiotic prescription data were collected from 11 adult and pediatric intensive care and general medical units at 6 hospitals in Maryland in 2014 and 2015. We performed a retrospective cohort study of all hospitalized patients who received any of 23 common antibiotics for at least 3 days. Each medical record was reviewed for demographics, admission and discharge dates, patient comorbidities, and antibiotic regimen by at least 1 infectious disease physician or pharmacist. Classification of antibiotic inappropriateness was based on each institution’s guidelines and standards. Bivariate analyses were performed using logistic regression for both initial therapy and therapy at days 3–5. Multivariable logistic regression was performed using covariates meeting the significance level of P < .05. Results: In total, 3,436 antibiotic courses were assessed at time of initial therapy, and 1541 regimens were continued and reviewed again at days 3–5 of therapy. For the initial therapy, 1,255 regimens (37%) were inappropriate; 45% of these were considered unnecessary and 41% were too broad in spectrum. In the multivariable regression, older age and antibiotic prescription during the summer were associated with the receipt of inappropriate antibiotics (Table 1). Having end-stage renal disease as a comorbid condition was protective against inappropriate use. At days 3–5 of therapy, 688 (45%) of the antibiotic courses were inappropriate. Reasons regimens were considered inappropriate included unnecessary antibiotic prescriptions (49%) and antibiotics being too broad (38%). Older age and receiving cefepime or piperacillin-tazobactam on day 3 of therapy were factors associated with inappropriate use (Table 2). Having undergone a transplant or a surgical procedure was protective of inappropriate antimicrobial use at days 3–5 of therapy. Conclusions: Older patients are more likely to receive inappropriate antibiotics at both initial regimen and 3–5 days later. Patients receiving cefepime or piperacillin-tazobactam are at greater risk of receiving inappropriate antibiotics at days 3–5 due to failure to de-escalate. Antibiotic stewardship strategies targeting these patient populations may limit inappropriate use.Funding: NoneDisclosures: None

Risk Factors for Inappropriate Antimicrobial Therapy Among Patients with Hospital-Acquired Infection at Jimma Medical Center: A Prospective Observational Study

“… 24 On the other hand, patients who were taking vancomycin had nearly three times at increased risk of inappropriate AMT use than patients not taking it. This is different from Pakistan, 28 Switzerland, 32 and Maryland 49 studies, where cephalosporin use, penicillin with β-lactamase inhibitors and cephalosporin use, and cefepime or piperacillin-tazobactam use were factors associated with inappropriate use of antibiotics, respectively. This inconsistency might be due to the possibility of variation in the availability, cost, and utilization of antibiotics across the countries.…”

Point prevalence of antibiotic usage in major referral hospital in Turkey

“…In a multicenter study, older age, prescription in summer were detected as risk factors for initial inappropriate antibiotic use, while end-stage renal disease was found to be a protective factor from inappropriate use. In the same study patients receiving cefepime or piperacillin-tazobactam were reported to be at greater risk of receiving inappropriate antibiotics on days 3–5 due to the failure to de-escalate [ 44 ]. Elderly people are often hospitalized as there is a higher risk of infection and infection-related adverse outcomes, multiple comorbidities and polypharmacotherapy.…”