MRSA prevalence and hospital-level antibiotic use: A retrospective study across 122 acute-care hospitals

Livorsi, Daniel J; Nair, Rajeshwari; Lund, Brian C.; Alexander, Bruce; Beck, Brice; Goto, Michihiko; Perencevich, Eli N.

doi:10.1017/ice.2020.429

Cited by 2 publications

(1 citation statement)

References 9 publications

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“…Although a recent study has also shown that MRSA prevalence has an effect on hospital-level anti-MRSA agent use, validation of this novel method of adjusting AU and comparison with other formulas for adjustment would be valuable in future studies. 13 Contrary to most traditional stewardship metrics, this novel metric may encourage healthcare providers to obtain appropriate cultures. Obtaining blood cultures with subsequent growth of P. aeruginosa, for example, justifies the use of APBLs in patients with sepsis.…”

Section: Discussionmentioning

confidence: 99%

Novel method of calculating adjusted antibiotic use by microbiological burden

Winders

Al-Hasan

Jones

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: To determine the usefulness of adjusting antibiotic use (AU) by prevalence of bacterial isolates as an alternative method for risk adjustment beyond hospital characteristics. Design: Retrospective, observational, cross-sectional study. Setting: Hospitals in the southeastern United States. Methods: AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared. Results: Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016. Conclusions: The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.

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Section: Discussionmentioning

confidence: 99%