Trends in infections and antibiotic usage in a community hospital

The results of a physician-performed prevalence survey of infections and antibiotic use at the Salt Lake City LDS Hospital in 1984 were compared with results of surveys done in 1971 and 1979. The hospital census and length of stay declined in successive surveys, contributing to the changes observed. Community-acquired infections were more prevalent in 1984 than in the previous surveys, whereas hospital-acquired infections were seen with similar frequencies. Among hospital-acquired infections, lower respiratory tract and soft-tissue infections were more prevalent in 1984. Gram-negative bacilli accounted for 34% of hospital-acquired infections in 1984 versus rates of 60% or more found in the 1970s. Although the overall prevalences of antibiotic use were similar in the three surveys, the proportion attributed to cephalosporins increased from 17.5% (1971) to 49.2% (1979) and 59.1% (1984). Antibiotic prophylaxis was less frequent in 1984 (14.4%) than in 1979 (24.1%) and reversed the trend found after 1971 (11.0%). Despite extensive educational efforts since the prevalence survey of 1979, perioperative antibiotics were used for durations longer than 48 hours after surgery in 43% of the patients receiving such prophylaxis in 1984. The LDS Hospital has adopted a restrictive antibiotic formulary in part as a result of the present survey.