Impact of antibiotic use on patient-level risk of death in 36 million hospital admissions in England.
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Author
Budgell, Eric PDavies, Timothy J
Donker, Tjibbe
Hopkins, Susan
Wyllie, David H
Peto, Tim E A
Gill, Martin J
Llewelyn, Martin J
Walker, A Sarah
Publication date
2021-12-25Subject
Microbiology. Immunology
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Objectives: Initiatives to curb hospital antibiotic use might be associated with harm from under-treatment. We examined the extent to which variation in hospital antibiotic prescribing is associated with mortality risk in acute/general medicine inpatients. Methods: This ecological analysis examined Hospital Episode Statistics from 36,124,372 acute/general medicine admissions (≥16y) to 135 acute hospitals in England, 01/April/2010-31/March/2017. Random-effects meta-regression was used to investigate whether heterogeneity in adjusted 30-day mortality was associated with hospital-level antibiotic use, measured in defined-daily-doses (DDD)/1,000 bed-days. Models also considered DDDs/1,000 admissions and DDDs for narrow-spectrum/broad-spectrum antibiotics, parenteral/oral, and local interpretations of World Health Organization Access, Watch, and Reserve antibiotics. Results: Hospital-level antibiotic DDDs/1,000 bed-days varied 15-fold with comparable variation in broad-spectrum, parenteral, and Reserve antibiotic use. After extensive adjusting for hospital case-mix, the probability of 30-day mortality changed -0.010% (95% CI: -0.064,+0.044) for each increase of 500 hospital-level antibiotic DDDs/1,000 bed-days. Analyses of other metrics of antibiotic use showed no consistent association with mortality risk. Conclusions: We found no evidence that wide variation in hospital antibiotic use is associated with adjusted mortality risk in acute/general medicine inpatients. Using low-prescribing hospitals as benchmarks could help drive safe and substantial reductions in antibiotic consumption of up-to one-third in this population.Citation
Budgell EP, Davies TJ, Donker T, Hopkins S, Wyllie DH, Peto TEA, Gill MJ, Llewelyn MJ, Walker AS. Impact of antibiotic use on patient-level risk of death in 36 million hospital admissions in England. J Infect. 2022 Mar;84(3):311-320. doi: 10.1016/j.jinf.2021.12.029. Epub 2021 Dec 25Type
ArticleOther
Additional Links
http://www.sciencedirect.com/science/journal/01634453PMID
34963640Journal
The Journal of InfectionPublisher
W.B. Saundersae974a485f413a2113503eed53cd6c53
10.1016/j.jinf.2021.12.029