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Published on: August 30, 2018
Calculation and Feedback of Risk-Adjusted Antibiotic Days as a Process Measure in a Statewide Trauma Collaborative
Naveen F Sangji1,2,3, Jacob M Dougherty1,2, Christopher J Tignanelli4,5
1Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Background:
Optimization of antibiotic stewardship requires determining appropriate antibiotic treatment and duration of use. Our current method of identifying infectious complications alone does not attempt to measure the resources actually utilized to treat infections in patients. We sought to develop a method accounting for treatment of infections and length of antibiotic administration to allow benchmarking of trauma hospitals with regard to days of antibiotic use.
Methods:
Using trauma quality collaborative data from 35 American College of Surgeons (ACS)-verified level I and level II trauma centers between November 1, 2020, and January 31, 2023, a two-part model was created to account for (1) the odds of any antibiotic use, using logistic regression; and (2) the duration of usage, using negative binomial distribution. We adjusted for injury severity, presence/type of infection (eg, ventilator-acquired pneumonia), infectious complications, and comorbid conditions. We performed observed-to-expected adjustments to calculate each center's risk-adjusted antibiotic days, bootstrapped Observed/Expected (O/E) ratios to create confidence intervals, and flagged potential high or low outliers as hospitals whose confidence intervals lay above or below the overall mean.
Results:
The mean antibiotic treatment days was 1.98°days with a total of 88,403 treatment days. A wide variation existed in risk-adjusted antibiotic treatment days (.76°days to 2.69°days). Several hospitals were identified as low (9 centers) or high (6 centers) outliers.
Conclusion:
There exists a wide variation in the duration of risk-adjusted antibiotic use amongst trauma centers. Further study is needed to address the underlying cause of variation and for improved antibiotic stewardship.
Insights
Trauma centers show significant variation in antibiotic use duration. This study developed a method to benchmark antibiotic days, revealing differences among hospitals for better antibiotic stewardship.
Area of Science:
- Trauma Care
- Infectious Diseases
- Health Services Research
Background:
- Antibiotic stewardship is crucial for optimizing treatment and resource utilization in trauma care.
- Current methods for identifying infectious complications do not quantify the resources used for treatment.
- A novel method is needed to benchmark antibiotic use duration in trauma hospitals.
Purpose of the Study:
- To develop and validate a method for benchmarking antibiotic use duration in trauma centers.
- To account for both the likelihood of antibiotic use and its duration.
- To identify variations in risk-adjusted antibiotic days across trauma facilities.
Main Methods:
- A two-part model using logistic regression and negative binomial distribution was applied to data from 35 trauma centers (2020-2023).
- The model adjusted for injury severity, infection type, complications, and comorbidities.
- Observed-to-expected ratios and confidence intervals were calculated to identify outlier centers.
Main Results:
- The mean antibiotic treatment duration was 1.98 days, with substantial variation observed (0.76 to 2.69 days).
- A total of 88,403 treatment days were analyzed.
- Nine centers were identified as low outliers and six as high outliers in antibiotic use.
Conclusions:
- Significant variation exists in risk-adjusted antibiotic use duration among trauma centers.
- Further research is necessary to understand the drivers of this variation.
- The findings support the need for improved antibiotic stewardship strategies in trauma care.
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