Appropriateness of Gram-Negative Agent Use at a Tertiary Care Hospital in the Setting of Significant Antimicrobial Resistance. (19th February 2015)

• Record Type: Journal Article
• Authors: Vora, Neil M.; Kubin, Christine J.; Furuya, E. Yoko
• Is Part Of: Open forum infectious diseases. Volume 2:Number 1(2015)
• Publication Date: 2015-02-19
• Subjects: antimicrobial agents -- gram-negative bacteria; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofv009
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract : Objective: Determine appropriateness of gram-negative antimicrobial agent use at an urban hospital. Despite antimicrobial stewardship efforts, 26% of agents were used suboptimally. A number of factors were identified that were associated with optimal and sub-optimal antimicrobial use Abstract: Background. Practicing antimicrobial stewardship in the setting of widespread antimicrobial resistance among gram-negative bacilli, particularly in urban areas, is challenging. Methods. We conducted a retrospective cross-sectional study at a tertiary care hospital with an established antimicrobial stewardship program in New York, New York to determine appropriateness of use of gram-negative antimicrobials and to identify factors associated with suboptimal antimicrobial use. Adult inpatients who received gram-negative agents on 2 dates, 1 June 2010 or 1 December 2010, were identified through pharmacy records. Clinical data were collected for each patient. Use of gram-negative agents was deemed optimal or suboptimal through chart review and according to hospital guidelines. Data were compared using χ 2 or Fischer's exact test for categorical variables and Student t test or Mann–Whitney U test for continuous variables. Results. A total of 356 patients were included who received 422 gram-negative agents. Administration was deemed suboptimal in 26% of instances, with the most common reason being spectrum of activity too broad. In multivariable analysis, being in an intensive care unit (adjusted odds ratio [aOR], .49; 95% confidence interval [CI], .29–.84), having an infectious diseases consultation within the previous 7 days (aOR, .52; 95% CI, .28–.98), and having a history of multidrug-resistant gram-negative bacilli within the past year (aOR, .24; 95% CI, .09–.65) were associated with optimal gram-negative agent use. Beta-lactam/beta-lactamase inhibitor combination drug use (aOR, 2.6; 95% CI, 1.35–5.16) was associated with suboptimal use. Conclusions. Gram-negative agents were used too broadly despite numerous antimicrobial stewardship program activities.