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Antimicrobial misuse in patients with positive blood cultures
W C Dunagan1, R S Woodward, G Medoff
1Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110.
Purpose:
Inappropriate antimicrobial use was examined among a randomly and prospectively selected cohort of patients with at least one positive result of blood cultures. This misuse was then analyzed with respect to hospital charges and length of stay (LOS).
Patients And Methods:
The study consisted of 70 patients (average age, 58.5 years) who had not undergone bone marrow transplantation. Patient charts were reviewed daily for the following information: clinical signs and symptoms of infection, pertinent laboratory data, culture results, detailed data on each antimicrobial in every antimicrobial regimen and their appropriateness, hospital charges, LOS, diagnostic and procedure codes, and discharge status. Three severity of illness variables were generated. Inappropriate antimicrobial use was described according to one of 12 categories.
Results:
The percent of antimicrobial misuse, defined as the proportion of days of administration of antimicrobials on which one or more antimicrobials were judged inappropriate, was found to be 22.3%. After adjustment for severity of illness and diagnosis, this average inappropriateness correlated with 4.2 additional hospitalization days and $5,368 additional hospital charges.
Conclusion:
Our results cannot distinguish among several possible reasons for these associations, including direct causality (e.g., toxicity and prolonged hospitalization for antimicrobial use) and indirect links such as inappropriate utilization of other resources and influences of severity of illness on antimicrobial use not accounted for in our equations. Nevertheless, the magnitude of the association gives import to the desirability of further studies.
Insights
Inappropriate antimicrobial use in patients with positive blood cultures led to longer hospital stays and increased costs. This highlights the need for optimizing antimicrobial prescribing practices to improve patient outcomes and reduce healthcare expenses.
Area of Science:
- Infectious Diseases
- Health Services Research
- Pharmacoeconomics
Background:
- Antimicrobial misuse is a significant concern in healthcare settings.
- Optimizing antimicrobial therapy is crucial for patient outcomes and resource management.
Purpose of the Study:
- To evaluate the extent of inappropriate antimicrobial use in patients with positive blood cultures.
- To analyze the association between antimicrobial misuse, hospital charges, and length of stay (LOS).
Main Methods:
- Prospective cohort study of 70 patients with positive blood cultures.
- Daily chart review for clinical data, antimicrobial appropriateness, hospital charges, and LOS.
- Severity of illness and diagnosis were adjusted for in the analysis.
Main Results:
- 22.3% of antimicrobial days involved inappropriate use.
- Inappropriate antimicrobial use was associated with an average of 4.2 additional hospitalization days.
- This misuse correlated with an additional $5,368 in hospital charges per patient.
Conclusions:
- The study demonstrates a significant association between inappropriate antimicrobial use and increased healthcare utilization.
- While causality is not definitively established, the findings underscore the importance of judicious antimicrobial prescribing.
- Further research is warranted to explore the direct and indirect factors contributing to these associations.