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Published on: August 30, 2018
Prolonged antibiotic treatment durations for community-onset infections in Dutch hospitals
Sharon E J D van den Eijnde1,2, Jesper van Breeschoten3, Jurjen S Kingma4
1Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands.
Background:
Antibiotic stewardship programs (ASPs) aim to optimize antibiotic prescribing, as prolonged use increases the risk of adverse events, antimicrobial resistance, and unnecessary healthcare costs. This study aimed to determine the period prevalence of prolonged antibiotic treatment durations for community-onset infections in Dutch hospitals and to identify risk factors.
Methods:
A retrospective cohort study was conducted among adults treated for urinary tract infections (UTI), respiratory tract infections (RTI), or skin and soft tissue infections (SSTI) in four Dutch secondary care hospitals from January 1, 2021, to December 31, 2023. Patients were included if they were admitted for ≥12 hours and treated with antibiotics within 48 hours. Antibiotic prescriptions were linked to infectious diagnoses to calculate length of therapy and compared against national guidelines to assess prolonged treatment. Backward stepwise multivariable logistic regression was used to identify risk factors.
Results:
Of 9,878 admissions, 39.6% had UTIs, 44.9% RTIs, and 15.4% SSTIs. Prolonged antibiotic use was observed in 30%, with the highest proportion in RTIs (49.6%). Among RTIs, prolonged use occurred in 51.0% of community-acquired pneumonia (CAP) and 55.9% of aspiration pneumonia, with a combined median excess duration of 1.6 days (IQR: 0.9-3.6)). Prolonged use was 14.3% in UTIs and 13.1% in SSTIs. Risk factors included positive cultures, intravenous-to-oral switch, aspiration pneumonia or CAP (RTIs), and cystitis (UTIs).
Conclusions:
A high period prevalence of patients with RTIs receiving prolonged antibiotic treatment was observed. The identified risk factors should be considered in ASPs to improve prescribing and reduce non-guideline-concordant antibiotic therapy.
Insights
Prolonged antibiotic use is common, especially for respiratory infections in Dutch hospitals. Identifying risk factors can help antibiotic stewardship programs optimize prescribing and reduce unnecessary treatment durations.
Area of Science:
- Infectious Diseases
- Pharmacology
- Hospital Administration
Background:
- Antibiotic stewardship programs (ASPs) are crucial for optimizing antibiotic use.
- Prolonged antibiotic therapy increases risks of adverse events, antimicrobial resistance, and healthcare costs.
- This study investigated the prevalence and risk factors of prolonged antibiotic treatment for community-onset infections in Dutch hospitals.
Purpose of the Study:
- To determine the period prevalence of prolonged antibiotic treatment durations for common community-onset infections.
- To identify specific risk factors associated with prolonged antibiotic use in hospitalized patients.
- To inform strategies for improving antibiotic prescribing practices within Dutch healthcare settings.
Main Methods:
- Retrospective cohort study of adult patients in four Dutch hospitals (2021-2023).
- Inclusion criteria: admission ≥12 hours, antibiotic treatment within 48 hours.
- Analysis included linking prescriptions to diagnoses, comparing therapy length to national guidelines, and logistic regression for risk factor identification.
Main Results:
- 30% of 9,878 admissions received prolonged antibiotic treatment.
- Respiratory tract infections (RTIs) showed the highest prevalence (49.6%), particularly community-acquired pneumonia (51.0%) and aspiration pneumonia (55.9%).
- Risk factors included positive cultures, IV-to-oral switch, specific RTI diagnoses (pneumonia), and cystitis in UTIs.
Conclusions:
- A significant prevalence of prolonged antibiotic treatment was observed, especially for RTIs.
- Identified risk factors can guide ASPs in refining antibiotic prescribing protocols.
- Reducing non-guideline-concordant therapy is essential for antimicrobial stewardship.
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