Infection Control & Hospital Epidemiology
model included the hospital and patient covariates from the administrative databases (Table 2) using an exchangeable corre- lation structure. The best-fitting model was generated by back- ward selection, with prespecified, forced inclusion of hospital type, proportion of admissions by service, proportion of admis- sions that included an ICU stay, and proportion of admissions by
Table 2. Hospital Characteristics
∙ Hospital type ∙ Location ∙ Resource intensity weight ∙ Presence of infectious diseases physician ∙ Length of hospital stay ∙ Proportions of admissions by service, and ∙ Proportion of admissions that were elective, transferred from acute-care hospitals and that included an ICU stay ∙ Aggregate patient characteristics (age, sex)
Note. ICU, intensive care unit.
943
patient age.5 The observed (O) antibiotic use at each hospital was compared to the model-based expected (E) antibiotic use, and hospitals were ranked from lowest to highest according to the O:E ratio. Analyses were performed with SAS Enterprise Guide version 7.12 software (SAS Institute, Cary, NC).
Results Hospital characteristics and antibiotic use
Of 127 eligible hospitals, 73 (57%) participated in this study. Among these 73 facilities were 12 academic teaching hospitals (16%), 36 large community hospitals (49%), 17mediumcommunity hospitals, (23%) and 8 small community hospitals (11%). Wide variability (7-fold) in antibiotic usage was observed, ranging from 253 to 1,872 defined daily doses per 1,000 patient days. Table 3 displays hospital and aggregate patient characteristics of the hospitals, subdivided into quintiles of O:E ratio of antibiotic use.
Table 3. Hospital Characteristics Ranked by Observed to Expected Antibiotic Use Ratio (Lowest to Highest) Characteristic No. of facilities Median O:E ratio
Overall 73
1.0 Median DDD/1,000 PD
Hospital type, no. (%) Academic teaching or large community
Admitting service, % (IQR) Medical Surgical
Maternal/Obstetric Neonatal
Mental health Elective admissions, % (IQR) Admissions with ICU stay, % (IQR) 491.5 48 (65.8)
Quintile 1 14
0.7 366.3 11 (78.6)
Quintile 2 15
0.9 436.0 9 (60.0)
Quintile 3 15
1.0 479.9 12 (80.0)
Quintile 4 15
1.2 578.9 10 (66.7)
Quintile 5 14
1.5 758.4 6 (42.9)
23.4 (19.6–31.5) 21.9 (19.6–26.9) 24.5 (20.3–31.5) 25.9 (19.0–31.2) 22.6 (19.5–36.9) 34.2 (17.6–41.8) 60.8 (52.3–68.3) 64.8 (58.8–71.0) 60.8 (49.6–64.2) 59.5 (53.0–68.3) 58.0 (43.0–66.5) 55.2 (24.8–69.3) 6.3 (2.4–8.1) 6.2 (1.8–7.5) 1.2 (0.7–1.8)
4.6 (2.5–7.7) 4.6 (2.2–7.1) 1.2 (0.7–1.3)
Transfers from other acute-care hospitals, % (IQR) 1.9 (1.2–3.3) Patient age, mean y (SD)
Patient age, % (IQR) <18 y
18–65 y >65 y
Female patients, mean (SD)
Length of stay, % (SD) ≤2 d
≥10 d Resource intensity weight, mean (SD) 54.53 ± 6.80
4.5 (3.4–5.8) 1.7 (1.4–2.8) 55.31 ± 3.93
6.4 (3.1–8.1) 6.3 (2.5–7.7) 1.1 (0.9–2.7)
4.3 (0.0–6.9) 1.9 (1.2–2.6) 53.40 ± 5.62
7.1 (0.0–8.3) 6.9 (0.0–8.1) 1.1 (0.6–1.5)
6.1 (3.6–9.6) 2.7 (0.9–3.8) 55.31 ± 6.81
7.3 (4.7–10.0) 3.0 (0.2–6.7) 7.0 (4.5–9.7) 1.3 (0.6–2.7)
4.1 (0.7–6.7) 2.4 (0.9–3.5) 51.56 ± 8.94
2.3 (0.2–6.6) 1.1 (0.4–4.4)
64.6 (55.9–68.1) 66.9 (61.0–69.3) 64.4 (54.1–67.3) 60.7 (55.9–70.3) 64.6 (55.9–67.8) 60.3 (34.9–69.7) 4.3 (2.5–6.7)
3.0 (0.0–5.0) 2.7 (1.4–3.8) 57.32 ± 7.00
9.5 (4.7–13.0) 8.5 (4.1–12.4) 10.9 (6.4–13.5) 10.1 (1.8–14.4) 10.3 (7.5–15.3) 4.6 (1.3–11.8) 51.8 (49.2–54.8) 53.0 (51.7–55.9) 52.3 (47.7–54.7) 51.2 (49.2–54.8) 50.9 (43.7–55.9) 50.7 (43.5–53.0) 38.0 (33.5–44.2) 37.6 (35.1–41.6) 38.1 (31.8–42.0) 36.8 (33.6–48.4) 39.3 (28.0–42.6) 37.3 (33.9–52.6) 54.9 (52.4–56.6) 53.1 (52.2–54.5) 56.4 (53.9–57.4) 54.3 (49.6–56.9) 56.5 (55.5–57.8) 54.2 (48.3–55.6)
72.9 (68.5–78.6) 73.5 (70.6–78.3) 75.4 (70.1–78.8) 75.5 (64.7–78.3) 74.2 (69.0–78.6) 71.7 (66.4–79.7) 7.4 (5.5–8.5) 0.83 ± 0.39
7.3 (5.6–8.2) 0.81 ± 0.21
6.3 (5.2–8.1) 0.79 ± 0.41
Note. O:E observed to expected; DDD, defined daily dose; PD, patient days; IQR, interquartile ratio; SD, standard deviation.
8.0 (5.3–11.5) 7.1 (5.4–8.2) 0.88 ± 0.34
0.81 ± 0.42
7.8 (5.6–9.7) 0.83 ± 0.53
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