Although differences in antimicrobial use were observed in selected patient and antimicrobial groups, differences in the overall prevalence of hospital antimicrobial use were not observed from 2011 to 2015, according to a study recently published in Clinical Infectious Diseases.
Antimicrobial stewardship is necessary to control antimicrobial resistance and improve patient safety. In 2011, survey assessing the prevalence of antimicrobial use in hospitals found that 50% of patients received antimicrobial medications. The inappropriate use of antimicrobials in the hospital setting is common and contributes to the spread of resistant pathogens and other adverse events. Since the survey was conducted, recognition of the importance of antimicrobial stewardship has increased. Antimicrobial use tracking tools, stewardship program implementation guidance, and policies establishing stewardship have been established as a national priority.
In 2014, the US Centers for Disease Control and Prevention (CDC) recommended that all hospitals have stewardship programs and delineated 7 components of effective programs; the percentage of hospitals meeting all 7 elements increased from 41% in 2014 to 76% in 2017. Furthermore, efforts to improve antimicrobial use have continued on a national level. However, to provide a current view of antimicrobial use in hospitals and to describe any changes observed since 2011, the survey study was repeated.
In total, 6084 patients in 148 general, women’s, and children’s hospitals participating in the CDC’s Emerging Infections Program sites who received antimicrobials were included in the study. Data on antimicrobial medications were collected; the percentages of patients receiving antimicrobial medications were compared, and factors associated with antimicrobial use were evaluated.
Results showed that the combination of patient age and inpatient location was the most important factor associated with antimicrobial use. No difference in overall prevalence of antimicrobial use was noted among institutions. However, differences were observed in selected patient or antimicrobial groups. Compared with the results from 2011, there was a lower prevalence of antimicrobial use observed in neonatal critical care patients (32.0% vs 22.8%; P =.006) and in use of fluoroquinolone (11.9% vs 10.1%; P <.001). However, there was found to be a higher prevalence of third- and fourth-generation cephalosporin use (10.7% vs 12.2%; P =.002) and carbapenem use (2.7% vs 3.7%; P <.001) in 2015 vs 2011.
The study authors conclude that, “Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.”
Magill SS, O’Leary E, Ray SM; for the Emerging Infections Program Hospital Prevalence Survey Team. Antimicrobial use in US hospitals: comparison of results from emerging infections program prevalence surveys, 2015 and 2011 [published online June 10, 2020]. Clin Infect Dis. doi:10.1093/cid/ciaa373