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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Antimicrobial Use in U.S. Hospitals: Comparison of 2015 and 2023 Prevalence Surveys

Barbara C Keino1, Taniece Eure1, Rebecca Alkis Ramirez1

  • 1Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Open Forum Infectious Diseases
|August 5, 2026
PubMed
Abstract

Insights

Antimicrobial use in U.S. hospitals remained stable at approximately 50% of inpatients between 2015 and 2023. Despite overall stability, shifts in prescribing patterns by location and drug class indicate evolving practices.

Area of Science:

  • Infectious Diseases
  • Hospital Epidemiology
  • Public Health

Background:

  • Hospital antimicrobial use (AU) prevalence was assessed in 2011 and 2015, revealing approximately half of inpatients received antimicrobials.
  • A follow-up survey was conducted in 2023 to evaluate current antimicrobial prescribing trends in U.S. hospitals.

Purpose of the Study:

  • To assess changes in inpatient antimicrobial use (AU) prevalence in U.S. hospitals between 2015 and 2023.
  • To identify factors associated with current antimicrobial prescribing practices.

Main Methods:

  • Ten Emerging Infections Program (EIP) sites participated, surveying up to 25 hospitals each.
  • Medical records of randomly selected inpatients were reviewed to document AU on the survey day or day prior.
  • Multivariable log-binomial regression was used to identify factors associated with AU in 2023.

Main Results:

  • Antimicrobial stewardship programs were present in 98.6% of hospitals in 2023, up from 79.4% in 2015.
  • Overall AU prevalence was 49.7% in 2023, similar to 2015 (49.2% in participating hospitals).
  • Significant shifts observed include decreased AU in neonatal critical care and increased AU in mother-baby units, alongside a decline in fluoroquinolone use and an increase in third- or fourth-generation cephalosporins.

Conclusions:

  • Inpatient antimicrobial use remains high, with approximately one in two patients receiving treatment.
  • Evolving prescribing practices are evident in shifts by inpatient location and antimicrobial class.
  • Findings can inform targeted surveillance and antimicrobial stewardship interventions.
Keywords:
acute-care hospitalsantimicrobial drugsantimicrobial stewardshipantimicrobial useprevalence survey

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