Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

<jats:p>Objectives: To determine the extent to which variation in hospital antibiotic prescribing is associated with mortality risk in acute/general medicine inpatients. Design: Ecological analysis, using electronic health records from Hospital Episode Statistics (HES) and antibiotic data from IQVIA. Setting: 135 acute National Health Service (NHS) hospital Trusts in England. Participants: 36,124,372 acute/general medicine inpatients (≥16 years old at admission) admitted between 01/April/2010-31/March/2017 (median age 66 years, 50.4% female, 83.8% white ethnicity). Main outcome measures: Random-effects meta-regression was used to investigate whether heterogeneity in the adjusted probability of death within 30-days of admission was associated with hospital-level antibiotic use, measured in defined-daily-doses (DDD)/1,000 bed-days. Models also considered DDDs/1,000 admissions and DDDs for selected antibiotics, including narrow-spectrum/broad-spectrum, inpatient/outpatient, parenteral/oral, piperacillin-tazobactam and meropenem, and Public Health England interpretations of World Health Organization Access, Watch, and Reserve antibiotics. Secondary analyses examined 14-day mortality and non-elective re-admission to hospital within 30-days of discharge. Results: There was a 15-fold variation in hospital-level DDDs/1,000 bed-days and comparable or greater variation in broad-spectrum, parenteral, and Reserve antibiotic use. After adjusting for a wide range of admission factors to reflect varying case-mix across hospitals, the adjusted probability of 30-day mortality changed by -0.010% (95% CI: -0.064 to +0.044) for each increase in hospital-level antibiotic use of 500 DDDs/1,000 bed-days. Analyses focusing on other metrics of antibiotic use, sub-populations, and 14-day mortality also showed no consistent association with the adjusted probability of death. Discussion: We find no evidence that the wide variation in antibiotic use across NHS hospitals is associated with case-mix adjusted mortality risk in acute/general medicine inpatients. Our results indicate that hospital antibiotic use in the acute/general medicine population could be safely cut by up to one-third, greatly exceeding the 1% year-on-year reductions required of NHS hospitals.</jats:p>

Original publication

DOI

10.1101/2020.09.24.20199448

Type

Journal article

Publisher

Cold Spring Harbor Laboratory

Publication Date

25/09/2020