Journal article
Impact of hospital antibiotic use on patient-level risk of death among 36,124,372 acute and medical admissions in England
- Abstract:
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Objectives: Initiatives to curb hospital antibiotic use might be associated with harm from undertreatment. We examined the extent to which variation in hospital antibiotic prescribing is associated with mortality risk in acute/general medicine inpatients.
Methods: This ecological analysis examined Hospital Episode Statistics from 36,124,372 acute/general medicine admissions (≥16y) to 135 acute hospitals in England, 01/April/2010–31/March/2017. Random-effects meta-regression was used to investigate whether heterogeneity in adjusted 30-day mortality 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 narrow-spectrum/broad-spectrum antibiotics, parenteral/oral, and local interpretations of World Health Organization Access, Watch, and Reserve antibiotics.
Results: Hospital-level antibiotic DDDs/1,000 beddays varied 15-fold with comparable variation in broad-spectrum, parenteral, and Reserve antibiotic use. After extensive adjusting for hospital case-mix, the probability of 30-day mortality changed -0.010% (95% CI: -0.064,+0.044) for each increase of 500 hospital-level antibiotic DDDs/1,000 bed-days. Analyses of other metrics of antibiotic use showed no consistent association with mortality risk.
Conclusions: We found no evidence that wide variation in hospital antibiotic use is associated with adjusted mortality risk in acute/general medicine inpatients. Using low-prescribing hospitals as benchmarks could help drive safe and substantial reductions in antibiotic consumption of up-to one-third in this population.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, pdf, 2.1MB, Terms of use)
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- Publisher copy:
- 10.1016/j.jinf.2021.12.029
Authors
- Publisher:
- Elsevier
- Journal:
- Journal of Infection More from this journal
- Volume:
- 84
- Issue:
- 3
- Pages:
- 311-320
- Publication date:
- 2021-12-25
- Acceptance date:
- 2021-12-21
- DOI:
- ISSN:
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0163-4453
- Language:
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English
- Keywords:
- Pubs id:
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1226839
- Local pid:
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pubs:1226839
- Deposit date:
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2021-12-23
Terms of use
- Copyright holder:
- Budgell et al
- Copyright date:
- 2022
- Rights statement:
- © 2022 The Authors. Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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