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Antibiotic stewardship 'critical' in small community hospitals
The rate of antibiotic use in small community hospitals is similar to that of larger hospitals, study data show, prompting researchers to recommend that small hospitals become a focus of antibiotic stewardship efforts.
“Unfortunately, antibiotic stewardship programs and infectious diseases consultation are limited in many small hospitals. Describing antibiotic use in [small community hospitals (SCH] is the first step toward a better understanding of how to implement effective antibiotic stewardship programs in these settings,” Edward Stenehjem, MD, MSc, of the division of clinical epidemiology and infectious diseases at Intermountain Medical Center, Murray, Utah, and the division of infectious diseases at Stanford University School of Medicine, and colleagues wrote. “Evaluating antibiotic usage patterns in these facilities is a high priority, given that SCHs constitute the majority of acute care hospitals and national antibiotic stewardship requirements are forthcoming.”
Stenehjem and colleagues used the monthly antibiotic report from Intermountain Healthcare, a large health care provider in Utah and Idaho, to determine antibiotic use for 19 hospitals — four large hospitals and 15 SCHs — from 2011 to 2013.
Among the small hospitals, rates of antibiotic use varied widely, Stenehjem and colleagues reported: median 436 days (range, 133-671) of therapy per 1,000 patient-days. Rates were similar, however, to those reported in the large hospitals: median 509 days (range, 406-597) of therapy per 1,000 patient-days. The proportion of broad-spectrum antibiotics that accounted for all antibiotic use also was similar between small and large hospitals (26% vs. 32%).
The researchers acknowledged it would be difficult to compare Intermountain Healthcare’s antibiotic use with that of other health care networks because data on antibiotic use in community hospitals is lacking.
“SCHs in the United States will face significant challenges meeting the forthcoming national antibiotic stewardship requirements and improving antibiotic use due to limited access to infectious diseases physician and/or pharmacist leadership, limited information technology support and lack of antibiotic stewardship guidance directed specifically to SCHs,” Stenehjem and colleagues wrote. “Regardless of the challenges, given the high rates of antibiotic use and similar prescribing patterns compared with large community hospitals that we have described, implementing antibiotic stewardship programs in SCHs is critical.” – by Andy Polhamus
Disclosure: Stenehjem reports consulting for Durata Therapeutics and receiving a grant from Allergan. Please see the full study for a list of all other authors’ relevant financial disclosures.