A modified method for measuring antibiotic use in healthcare settings: Implications for antibiotic stewardship and benchmarking

M.A. Aldeyab, J.C. McElnay, M.G. Scott, W.J. Lattyak, F.W. Darwish Elhajji, M.A. Aldiab, F.A. Magee, G. Conlon, M.P. Kearney

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: To determine whether adjusting the denominator of the common hospital antibiotic use measurement unit (defined daily doses/100 bed-days) by including age-adjusted comorbidity score (100 bed-days/age-adjusted comorbidity score) would result in more accurate and meaningful assessment of hospital antibiotic use. Methods: The association between the monthly sum of age-adjusted comorbidity and monthly antibiotic use was measured using time-series analysis (January 2008 to June 2012). For the purposes of conducting internal benchmarking, two antibiotic usage datasets were constructed, i.e. 2004-07 (first study period) and 2008-11 (second study period). Monthly antibiotic use was normalized per 100 bed-days and per 100 bed-days/age-adjusted comorbidity score. Results: Results showed that antibiotic use had significant positive relationships with the sum of age-adjusted comorbidity score (P = 0.0004). The results also showed that there was a negative relationship between antibiotic use and (i) alcohol-based hand rub use (P = 0.0370) and (ii) clinical pharmacist activity (P = 0.0031). Normalizing antibiotic use per 100 bed-days contributed to a comparative usage rate of 1.31, i.e. the average antibiotic use during the second period was 31% higher than during the first period. However, normalizing antibiotic use per 100 bed-days per age-adjusted comorbidity score resulted in a comparative usage rate of 0.98, i.e. the average antibiotic use was 2% lower in the second study period. Importantly, the latter comparative usage rate is independent of differences in patient density and case mix characteristics between the two studied populations. Conclusions: The proposed modified antibiotic measure provides an innovative approach to compare variations in antibiotic prescribing while taking account of patient case mix effects. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
LanguageEnglish
Pages1132-1141
Number of pages9
JournalJournal of Antimicrobial Chemotherapy
Volume69
Issue number4
Early online date11 Nov 2013
DOIs
Publication statusPublished - 1 Apr 2014

Fingerprint

Benchmarking
Anti-Bacterial Agents
Delivery of Health Care
Comorbidity
Diagnosis-Related Groups
Pharmacists

Keywords

  • Age-adjusted comorbidity index
  • Antibiotic measure
  • Pharmacoepidemiology
  • Time-series analysis
  • aminoglycoside derivative
  • amoxicillin plus clavulanic acid
  • antibiotic agent
  • antiinfective agent
  • carbapenem derivative
  • cephalosporin derivative
  • chloramphenicol
  • glycopeptide
  • imidazole derivative
  • lincosamide
  • macrolide
  • monobactam derivative
  • nitrofuran derivative
  • penicillin derivative
  • quinolone derivative
  • steroid
  • streptomycin derivative
  • sulfonamide
  • tetracycline derivative
  • trimethoprim derivative
  • antibiotic therapy
  • article
  • Clostridium difficile infection
  • comorbidity
  • drug utilization
  • hospital care
  • human
  • observational study
  • pharmacist
  • quality control
  • time series analysis
  • age-adjusted comorbidity index
  • antibiotic measure
  • pharmacoepidemiology
  • time-series analysis
  • Adult
  • Anti-Bacterial Agents
  • Benchmarking
  • Drug Prescriptions
  • Drug Utilization
  • Health Facilities
  • Humans

Cite this

Aldeyab, M. A., McElnay, J. C., Scott, M. G., Lattyak, W. J., Darwish Elhajji, F. W., Aldiab, M. A., ... Kearney, M. P. (2014). A modified method for measuring antibiotic use in healthcare settings: Implications for antibiotic stewardship and benchmarking. Journal of Antimicrobial Chemotherapy, 69(4), 1132-1141. https://doi.org/10.1093/jac/dkt458
Aldeyab, M.A. ; McElnay, J.C. ; Scott, M.G. ; Lattyak, W.J. ; Darwish Elhajji, F.W. ; Aldiab, M.A. ; Magee, F.A. ; Conlon, G. ; Kearney, M.P. / A modified method for measuring antibiotic use in healthcare settings: Implications for antibiotic stewardship and benchmarking. In: Journal of Antimicrobial Chemotherapy. 2014 ; Vol. 69, No. 4. pp. 1132-1141.
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title = "A modified method for measuring antibiotic use in healthcare settings: Implications for antibiotic stewardship and benchmarking",
abstract = "Objectives: To determine whether adjusting the denominator of the common hospital antibiotic use measurement unit (defined daily doses/100 bed-days) by including age-adjusted comorbidity score (100 bed-days/age-adjusted comorbidity score) would result in more accurate and meaningful assessment of hospital antibiotic use. Methods: The association between the monthly sum of age-adjusted comorbidity and monthly antibiotic use was measured using time-series analysis (January 2008 to June 2012). For the purposes of conducting internal benchmarking, two antibiotic usage datasets were constructed, i.e. 2004-07 (first study period) and 2008-11 (second study period). Monthly antibiotic use was normalized per 100 bed-days and per 100 bed-days/age-adjusted comorbidity score. Results: Results showed that antibiotic use had significant positive relationships with the sum of age-adjusted comorbidity score (P = 0.0004). The results also showed that there was a negative relationship between antibiotic use and (i) alcohol-based hand rub use (P = 0.0370) and (ii) clinical pharmacist activity (P = 0.0031). Normalizing antibiotic use per 100 bed-days contributed to a comparative usage rate of 1.31, i.e. the average antibiotic use during the second period was 31{\%} higher than during the first period. However, normalizing antibiotic use per 100 bed-days per age-adjusted comorbidity score resulted in a comparative usage rate of 0.98, i.e. the average antibiotic use was 2{\%} lower in the second study period. Importantly, the latter comparative usage rate is independent of differences in patient density and case mix characteristics between the two studied populations. Conclusions: The proposed modified antibiotic measure provides an innovative approach to compare variations in antibiotic prescribing while taking account of patient case mix effects. {\circledC} The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.",
keywords = "Age-adjusted comorbidity index, Antibiotic measure, Pharmacoepidemiology, Time-series analysis, aminoglycoside derivative, amoxicillin plus clavulanic acid, antibiotic agent, antiinfective agent, carbapenem derivative, cephalosporin derivative, chloramphenicol, glycopeptide, imidazole derivative, lincosamide, macrolide, monobactam derivative, nitrofuran derivative, penicillin derivative, quinolone derivative, steroid, streptomycin derivative, sulfonamide, tetracycline derivative, trimethoprim derivative, antibiotic therapy, article, Clostridium difficile infection, comorbidity, drug utilization, hospital care, human, observational study, pharmacist, quality control, time series analysis, age-adjusted comorbidity index, antibiotic measure, pharmacoepidemiology, time-series analysis, Adult, Anti-Bacterial Agents, Benchmarking, Drug Prescriptions, Drug Utilization, Health Facilities, Humans",
author = "M.A. Aldeyab and J.C. McElnay and M.G. Scott and W.J. Lattyak and {Darwish Elhajji}, F.W. and M.A. Aldiab and F.A. Magee and G. Conlon and M.P. Kearney",
note = "Cited By :6 Export Date: 15 September 2018 CODEN: JACHD Correspondence Address: Aldeyab, M.A.; Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, Northern Ireland, United Kingdom; email: maldeyab02@qub.ac.uk Chemicals/CAS: amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; chloramphenicol, 134-90-7, 2787-09-9, 56-75-7; lincosamide, 80738-43-8 References: Patrick, D.M., Hutchinson, J., Antibiotic use and population ecology: howyou can reduce your {"}resistance footprint{"} (2009) CMAJ, 180, pp. 416-421; Goossens, H., Antibiotic consumption and link to resistance (2009) Clin Microbiol Infect, 15 (SUPPL. 3), pp. 12-15; Hecker, M.T., Aron, D.C., Patel, N.P., Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity (2003) Arch Intern Med, 163, pp. 972-978; Gould, I.M., Antibiotic policies to control hospital-acquired infection (2008) J Antimicrob Chemother, 61, pp. 763-765; Wilcox, M.H., Dave, J., The cost of hospital-acquired infection and the value of infection control (2000) J Hosp Infect, 45, pp. 81-84; Gould, I.M., The clinical significance of methicillin-resistant Staphylococcus aureus (2005) J Hosp Infect, 61, pp. 277-282; Fishman, N., Antimicrobial stewardship (2006) Am J Med, 119 (SUPPL. 1), pp. S53-61; Griffith, M., Postelnick, M., Scheetz, M., Antimicrobial stewardship programs: methods of operation and suggested outcomes (2012) Expert Rev Anti Infect Ther, 10, pp. 63-73; Dellit, T.H., Owens, R.C., McGowan Jr., J.E., Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship (2007) Clin Infect Dis, 44, pp. 159-177; Davey, P., Brown, E., Fenelon, L., Interventions to improve antibiotic prescribing practices for hospital inpatients (2005) Cochrane Database Syst Rev, (4). , CD003543; (2012) Guidelines for ATC Classification and DDD Assignment, , http://www.whocc.no/atc_ddd_publications/guidelines/, WHO Collaborating Centre for Drug Statistics Methodology. Oslo, 2011. (20 September 2012, date last accessed); Filius, P.M., Liem, T.B., van der Linden, P.D., An additional measure for quantifying antibiotic use in hospitals (2005) J Antimicrob Chemother, 55, pp. 805-808; Cooke, J., Trends in antimicrobial prescribing (2000) J Antimicrob Chemother, 46, p. 639; Ibrahim, O.M., Polk, R.E., Benchmarking antimicrobial drug use in hospitals (2012) Expert Rev Anti Infect Ther, 10, pp. 445-457; Aldeyab, M.A., McElnay, J.C., Scott, M.G., Hospital antibiotic use and its relationship to age-adjusted co-morbidity and alcohol-based hand rub consumption (2013) Epidemiol Infect, 9. , doi:10.1017/S0950268813001052; Charlson, M.E., Pompei, P., Ales, K.L., A new method of classifying prognostic comorbidity in longitudinal studies: development and validation (1987) J Chronic Dis, 40, pp. 373-383; Tobacman, J.K., Assessment of comorbidity: a review (1994) Clin Perform Qual Health Care, 2, pp. 23-32; Peterson, J.C., Paget, S.A., Lachs, M.S., Therisk ofcomorbidity (2012) AnnRheum Dis, 71, pp. 635-637; Aldeyab, M.A., Devine, M.J., Flanagan, P., Multihospital outbreak of Clostridium difficile ribotype 027 infection: epidemiology and analysis of control measures (2011) Infect Control Hosp Epidemiol, 32, pp. 210-219; Aldeyab, M.A., Kearney, M.P., Scott, M.G., An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings (2012) J Antimicrob Chemother, 67, pp. 2988-2996; Conlon, G., Aldeyab, M.A., McElnay, J.C., Improving and maintaining adherence with hospital antibiotic policies: a strategy for success (2011) J Hosp Infect, 77, pp. 88-89; Box, G.E.P., Jenkins, G.M., (1976) Time Series Analysis: Forecasting and Control, , San Francisco: Holden Day; Box, G.E.P., Jenkins, G.M., Reinsel, G.C., (1994) Time Series Analysis: Forecasting and Control, , 3rd edn. Englewood Cliff, NJ: Prentice Hall; Aldeyab, M.A., Monnet, D.L., L{\'o}pez-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospitalacquired methicillin-resistant Staphylococcus aureus: a time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; Dickey, D.A., Fuller, W.A., Distribution of estimators for autoregressive time series with a unit root (1979) JASA, 74, pp. 427-431; Liu, L.-M., Hanssens, D.M., Identification of multiple-input transfer function models (1982) Commun Stat, A11, pp. 297-314; Liu, L.-M., (2006) Time Series Analysis and Forecasting, , SecondEdition. Chicago, IL: Scientific Computing Associates Corporation; Vander Stichele, R.H., Elseviers, M.M., Ferech, M., Hospital consumption of antibiotics in 15 European countries: results of the ESAC Retrospective Data Collection (1997-2002) (2006) J Antimicrob Chemother, 58, pp. 159-167; Lesch, C.A., Itokazu, G.S., Danziger, L.H., Multi-hospital analysis of antimicrobial usage and resistance trends (2001) Diagn Microbiol Infect Dis, 41, pp. 149-154; Kislak, J.W., Eickhoff, T.C., Finland, M., Hospital-acquired infections and antibiotic usage in the Boston City Hospital-January, 1964 (1964) N Engl J Med, 271, pp. 834-835; Werner, N.L., Hecker, M.T., Sethi, A.K., Unnecessary use of fluoroquinolone antibiotics in hospitalized patients (2011) BMC Infect Dis, 11, p. 187; Kuster, S.P., Ruef, C., Bollinger, A.K., Correlation between case mix index and antibiotic use in hospitals (2008) J Antimicrob Chemother, 62. , 837-482; Rogues, A.M., Placet-Thomazeau, B., Parneix, P., Use of antibiotics in hospitals in south-western France (2004) J Hosp Infect, 58, pp. 187-192; Polk, R.E., Hohmann, S.F., Medvedev, S., Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals (2011) Clin Infect Dis, 53, pp. 1100-1110; Jarlier, V., Trystram, D., Brun-Buisson, C., Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program (2010) Arch Intern Med, 170, pp. 552-559; Vernaz, N., Sax, H., Pittet, D., Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile (2008) J Antimicrob Chemother, 62, pp. 601-607; MacKenzie, F.M., Lopez-Lozano, J.M., Monnet, D.L., Temporal relationship between prevalence of meticillin-resistant Staphylococcus aureus (MRSA) in one hospital and prevalence of MRSA in the surrounding community: a time-series analysis (2007) J Hosp Infect, 67, pp. 225-231; Burnett, K.M., Scott, M.G., Fleming, G.F., Effects of an integrated medicines management program on medication appropriateness in hospitalized patients (2009) Am J Health Syst Pharm, 66, pp. 854-859; Shardell, M., Harris, A.D., El-Kamary, S.S., Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies (2007) Clin Infect Dis, 45, pp. 901-907; Aldeyab, M.A., Harbarth, S., Vernaz, N., The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum β-lactamase-producing bacteria in primary and secondary healthcare settings (2012) Br J Clin Pharmacol, 74, pp. 171-179; Aldeyab, M.A., Scott, M.G., Kearney, M.P., Impact of an enhanced antibiotic stewardship on reducing methicillin-resistant Staphylococcus aureus in primary and secondary healthcare settings (2013) Epidemiol Infect, 5, pp. 1-7; Aldeyab, M.A., Kearney, M.P., McElnay, J.C., A point prevalence survey of antibiotic prescriptions: benchmarking and patterns of use (2011) Br J Clin Pharmacol, 71, pp. 293-296; Aldeyab, M.A., Elshibly, S.M., McElnay, J.C., An evaluation of compliance with an antibiotic policy in surgical wards at a general teaching hospital in Northern Ireland (2009) Infect Control Hosp Epidemiol, 30, pp. 921-922",
year = "2014",
month = "4",
day = "1",
doi = "10.1093/jac/dkt458",
language = "English",
volume = "69",
pages = "1132--1141",
journal = "Journal of Antimicrobial Chemotherapy",
issn = "0305-7453",
number = "4",

}

Aldeyab, MA, McElnay, JC, Scott, MG, Lattyak, WJ, Darwish Elhajji, FW, Aldiab, MA, Magee, FA, Conlon, G & Kearney, MP 2014, 'A modified method for measuring antibiotic use in healthcare settings: Implications for antibiotic stewardship and benchmarking', Journal of Antimicrobial Chemotherapy, vol. 69, no. 4, pp. 1132-1141. https://doi.org/10.1093/jac/dkt458

A modified method for measuring antibiotic use in healthcare settings: Implications for antibiotic stewardship and benchmarking. / Aldeyab, M.A.; McElnay, J.C.; Scott, M.G.; Lattyak, W.J.; Darwish Elhajji, F.W.; Aldiab, M.A.; Magee, F.A.; Conlon, G.; Kearney, M.P.

In: Journal of Antimicrobial Chemotherapy, Vol. 69, No. 4, 01.04.2014, p. 1132-1141.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A modified method for measuring antibiotic use in healthcare settings: Implications for antibiotic stewardship and benchmarking

AU - Aldeyab, M.A.

AU - McElnay, J.C.

AU - Scott, M.G.

AU - Lattyak, W.J.

AU - Darwish Elhajji, F.W.

AU - Aldiab, M.A.

AU - Magee, F.A.

AU - Conlon, G.

AU - Kearney, M.P.

N1 - Cited By :6 Export Date: 15 September 2018 CODEN: JACHD Correspondence Address: Aldeyab, M.A.; Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, Northern Ireland, United Kingdom; email: maldeyab02@qub.ac.uk Chemicals/CAS: amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; chloramphenicol, 134-90-7, 2787-09-9, 56-75-7; lincosamide, 80738-43-8 References: Patrick, D.M., Hutchinson, J., Antibiotic use and population ecology: howyou can reduce your "resistance footprint" (2009) CMAJ, 180, pp. 416-421; Goossens, H., Antibiotic consumption and link to resistance (2009) Clin Microbiol Infect, 15 (SUPPL. 3), pp. 12-15; Hecker, M.T., Aron, D.C., Patel, N.P., Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity (2003) Arch Intern Med, 163, pp. 972-978; Gould, I.M., Antibiotic policies to control hospital-acquired infection (2008) J Antimicrob Chemother, 61, pp. 763-765; Wilcox, M.H., Dave, J., The cost of hospital-acquired infection and the value of infection control (2000) J Hosp Infect, 45, pp. 81-84; Gould, I.M., The clinical significance of methicillin-resistant Staphylococcus aureus (2005) J Hosp Infect, 61, pp. 277-282; Fishman, N., Antimicrobial stewardship (2006) Am J Med, 119 (SUPPL. 1), pp. S53-61; Griffith, M., Postelnick, M., Scheetz, M., Antimicrobial stewardship programs: methods of operation and suggested outcomes (2012) Expert Rev Anti Infect Ther, 10, pp. 63-73; Dellit, T.H., Owens, R.C., McGowan Jr., J.E., Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship (2007) Clin Infect Dis, 44, pp. 159-177; Davey, P., Brown, E., Fenelon, L., Interventions to improve antibiotic prescribing practices for hospital inpatients (2005) Cochrane Database Syst Rev, (4). , CD003543; (2012) Guidelines for ATC Classification and DDD Assignment, , http://www.whocc.no/atc_ddd_publications/guidelines/, WHO Collaborating Centre for Drug Statistics Methodology. Oslo, 2011. (20 September 2012, date last accessed); Filius, P.M., Liem, T.B., van der Linden, P.D., An additional measure for quantifying antibiotic use in hospitals (2005) J Antimicrob Chemother, 55, pp. 805-808; Cooke, J., Trends in antimicrobial prescribing (2000) J Antimicrob Chemother, 46, p. 639; Ibrahim, O.M., Polk, R.E., Benchmarking antimicrobial drug use in hospitals (2012) Expert Rev Anti Infect Ther, 10, pp. 445-457; Aldeyab, M.A., McElnay, J.C., Scott, M.G., Hospital antibiotic use and its relationship to age-adjusted co-morbidity and alcohol-based hand rub consumption (2013) Epidemiol Infect, 9. , doi:10.1017/S0950268813001052; Charlson, M.E., Pompei, P., Ales, K.L., A new method of classifying prognostic comorbidity in longitudinal studies: development and validation (1987) J Chronic Dis, 40, pp. 373-383; Tobacman, J.K., Assessment of comorbidity: a review (1994) Clin Perform Qual Health Care, 2, pp. 23-32; Peterson, J.C., Paget, S.A., Lachs, M.S., Therisk ofcomorbidity (2012) AnnRheum Dis, 71, pp. 635-637; Aldeyab, M.A., Devine, M.J., Flanagan, P., Multihospital outbreak of Clostridium difficile ribotype 027 infection: epidemiology and analysis of control measures (2011) Infect Control Hosp Epidemiol, 32, pp. 210-219; Aldeyab, M.A., Kearney, M.P., Scott, M.G., An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings (2012) J Antimicrob Chemother, 67, pp. 2988-2996; Conlon, G., Aldeyab, M.A., McElnay, J.C., Improving and maintaining adherence with hospital antibiotic policies: a strategy for success (2011) J Hosp Infect, 77, pp. 88-89; Box, G.E.P., Jenkins, G.M., (1976) Time Series Analysis: Forecasting and Control, , San Francisco: Holden Day; Box, G.E.P., Jenkins, G.M., Reinsel, G.C., (1994) Time Series Analysis: Forecasting and Control, , 3rd edn. Englewood Cliff, NJ: Prentice Hall; Aldeyab, M.A., Monnet, D.L., López-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospitalacquired methicillin-resistant Staphylococcus aureus: a time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; Dickey, D.A., Fuller, W.A., Distribution of estimators for autoregressive time series with a unit root (1979) JASA, 74, pp. 427-431; Liu, L.-M., Hanssens, D.M., Identification of multiple-input transfer function models (1982) Commun Stat, A11, pp. 297-314; Liu, L.-M., (2006) Time Series Analysis and Forecasting, , SecondEdition. Chicago, IL: Scientific Computing Associates Corporation; Vander Stichele, R.H., Elseviers, M.M., Ferech, M., Hospital consumption of antibiotics in 15 European countries: results of the ESAC Retrospective Data Collection (1997-2002) (2006) J Antimicrob Chemother, 58, pp. 159-167; Lesch, C.A., Itokazu, G.S., Danziger, L.H., Multi-hospital analysis of antimicrobial usage and resistance trends (2001) Diagn Microbiol Infect Dis, 41, pp. 149-154; Kislak, J.W., Eickhoff, T.C., Finland, M., Hospital-acquired infections and antibiotic usage in the Boston City Hospital-January, 1964 (1964) N Engl J Med, 271, pp. 834-835; Werner, N.L., Hecker, M.T., Sethi, A.K., Unnecessary use of fluoroquinolone antibiotics in hospitalized patients (2011) BMC Infect Dis, 11, p. 187; Kuster, S.P., Ruef, C., Bollinger, A.K., Correlation between case mix index and antibiotic use in hospitals (2008) J Antimicrob Chemother, 62. , 837-482; Rogues, A.M., Placet-Thomazeau, B., Parneix, P., Use of antibiotics in hospitals in south-western France (2004) J Hosp Infect, 58, pp. 187-192; Polk, R.E., Hohmann, S.F., Medvedev, S., Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals (2011) Clin Infect Dis, 53, pp. 1100-1110; Jarlier, V., Trystram, D., Brun-Buisson, C., Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program (2010) Arch Intern Med, 170, pp. 552-559; Vernaz, N., Sax, H., Pittet, D., Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile (2008) J Antimicrob Chemother, 62, pp. 601-607; MacKenzie, F.M., Lopez-Lozano, J.M., Monnet, D.L., Temporal relationship between prevalence of meticillin-resistant Staphylococcus aureus (MRSA) in one hospital and prevalence of MRSA in the surrounding community: a time-series analysis (2007) J Hosp Infect, 67, pp. 225-231; Burnett, K.M., Scott, M.G., Fleming, G.F., Effects of an integrated medicines management program on medication appropriateness in hospitalized patients (2009) Am J Health Syst Pharm, 66, pp. 854-859; Shardell, M., Harris, A.D., El-Kamary, S.S., Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies (2007) Clin Infect Dis, 45, pp. 901-907; Aldeyab, M.A., Harbarth, S., Vernaz, N., The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum β-lactamase-producing bacteria in primary and secondary healthcare settings (2012) Br J Clin Pharmacol, 74, pp. 171-179; Aldeyab, M.A., Scott, M.G., Kearney, M.P., Impact of an enhanced antibiotic stewardship on reducing methicillin-resistant Staphylococcus aureus in primary and secondary healthcare settings (2013) Epidemiol Infect, 5, pp. 1-7; Aldeyab, M.A., Kearney, M.P., McElnay, J.C., A point prevalence survey of antibiotic prescriptions: benchmarking and patterns of use (2011) Br J Clin Pharmacol, 71, pp. 293-296; Aldeyab, M.A., Elshibly, S.M., McElnay, J.C., An evaluation of compliance with an antibiotic policy in surgical wards at a general teaching hospital in Northern Ireland (2009) Infect Control Hosp Epidemiol, 30, pp. 921-922

PY - 2014/4/1

Y1 - 2014/4/1

N2 - Objectives: To determine whether adjusting the denominator of the common hospital antibiotic use measurement unit (defined daily doses/100 bed-days) by including age-adjusted comorbidity score (100 bed-days/age-adjusted comorbidity score) would result in more accurate and meaningful assessment of hospital antibiotic use. Methods: The association between the monthly sum of age-adjusted comorbidity and monthly antibiotic use was measured using time-series analysis (January 2008 to June 2012). For the purposes of conducting internal benchmarking, two antibiotic usage datasets were constructed, i.e. 2004-07 (first study period) and 2008-11 (second study period). Monthly antibiotic use was normalized per 100 bed-days and per 100 bed-days/age-adjusted comorbidity score. Results: Results showed that antibiotic use had significant positive relationships with the sum of age-adjusted comorbidity score (P = 0.0004). The results also showed that there was a negative relationship between antibiotic use and (i) alcohol-based hand rub use (P = 0.0370) and (ii) clinical pharmacist activity (P = 0.0031). Normalizing antibiotic use per 100 bed-days contributed to a comparative usage rate of 1.31, i.e. the average antibiotic use during the second period was 31% higher than during the first period. However, normalizing antibiotic use per 100 bed-days per age-adjusted comorbidity score resulted in a comparative usage rate of 0.98, i.e. the average antibiotic use was 2% lower in the second study period. Importantly, the latter comparative usage rate is independent of differences in patient density and case mix characteristics between the two studied populations. Conclusions: The proposed modified antibiotic measure provides an innovative approach to compare variations in antibiotic prescribing while taking account of patient case mix effects. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

AB - Objectives: To determine whether adjusting the denominator of the common hospital antibiotic use measurement unit (defined daily doses/100 bed-days) by including age-adjusted comorbidity score (100 bed-days/age-adjusted comorbidity score) would result in more accurate and meaningful assessment of hospital antibiotic use. Methods: The association between the monthly sum of age-adjusted comorbidity and monthly antibiotic use was measured using time-series analysis (January 2008 to June 2012). For the purposes of conducting internal benchmarking, two antibiotic usage datasets were constructed, i.e. 2004-07 (first study period) and 2008-11 (second study period). Monthly antibiotic use was normalized per 100 bed-days and per 100 bed-days/age-adjusted comorbidity score. Results: Results showed that antibiotic use had significant positive relationships with the sum of age-adjusted comorbidity score (P = 0.0004). The results also showed that there was a negative relationship between antibiotic use and (i) alcohol-based hand rub use (P = 0.0370) and (ii) clinical pharmacist activity (P = 0.0031). Normalizing antibiotic use per 100 bed-days contributed to a comparative usage rate of 1.31, i.e. the average antibiotic use during the second period was 31% higher than during the first period. However, normalizing antibiotic use per 100 bed-days per age-adjusted comorbidity score resulted in a comparative usage rate of 0.98, i.e. the average antibiotic use was 2% lower in the second study period. Importantly, the latter comparative usage rate is independent of differences in patient density and case mix characteristics between the two studied populations. Conclusions: The proposed modified antibiotic measure provides an innovative approach to compare variations in antibiotic prescribing while taking account of patient case mix effects. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

KW - Age-adjusted comorbidity index

KW - Antibiotic measure

KW - Pharmacoepidemiology

KW - Time-series analysis

KW - aminoglycoside derivative

KW - amoxicillin plus clavulanic acid

KW - antibiotic agent

KW - antiinfective agent

KW - carbapenem derivative

KW - cephalosporin derivative

KW - chloramphenicol

KW - glycopeptide

KW - imidazole derivative

KW - lincosamide

KW - macrolide

KW - monobactam derivative

KW - nitrofuran derivative

KW - penicillin derivative

KW - quinolone derivative

KW - steroid

KW - streptomycin derivative

KW - sulfonamide

KW - tetracycline derivative

KW - trimethoprim derivative

KW - antibiotic therapy

KW - article

KW - Clostridium difficile infection

KW - comorbidity

KW - drug utilization

KW - hospital care

KW - human

KW - observational study

KW - pharmacist

KW - quality control

KW - time series analysis

KW - age-adjusted comorbidity index

KW - antibiotic measure

KW - pharmacoepidemiology

KW - time-series analysis

KW - Adult

KW - Anti-Bacterial Agents

KW - Benchmarking

KW - Drug Prescriptions

KW - Drug Utilization

KW - Health Facilities

KW - Humans

U2 - 10.1093/jac/dkt458

DO - 10.1093/jac/dkt458

M3 - Article

VL - 69

SP - 1132

EP - 1141

JO - Journal of Antimicrobial Chemotherapy

T2 - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 4

ER -