Table 3.
Antibiotic (AB) prescribing in hospitals – process measures
| LRTI (n = 412) n (%) | COPD ex (n = 280) n (%) | Sepsis (n = 248) n (%) | SSTI (n = 150) n (%) | UTI (n = 145) n (%) | Total (N = 1235) n (%) | |
|---|---|---|---|---|---|---|
| AB initiated | ||||||
| Emergency room | 320 (77.7) | 244 (87.1) | 240 (96.8) | 135 (90.0) | 94 (64.8) | 1033 (83.6) |
| Ward | 92 (22.3) | 36 (12.9) | 8 (3.2) | 15 (10.0) | 51 (35.2) | 202 (16.4) |
| Adherence to guideline | ||||||
| Yes | 280 (68.0) | 177 (63.2) | 151 (60.9) | 90 (60.0) | 80 (55.2) | 778 (63.0) |
| No | 132 (32.0) | 103 (36.8) | 97 (39.1) | 60 (40.0) | 65 (44.8) | 457 (37.0) |
| Accuracy between indication for AB-treatment and discharge infection diagnosesa | ||||||
| Yes | 331 (80.3) | 255 (91.1) | 103 (41.5) | 143 (95.3) | 122 (84.1) | 954 (77.3) |
| No | 81 (19.7) | 25 (8.9) | 145 (58.5) | 7 (4.7) | 23 (15.9) | 281 (22.8) |
| Empirical AB regimen was | ||||||
| Changed during admission | 232 (56.3) | 167 (59.6) | 205 (82.7) | 82 (54.7) | 73 (50.3) | 759 (61.4) |
| Changed at discharge | 99 (24.0) | 57 (20.4) | 22 (8.9) | 57 (38.0) | 19 (13.1) | 254 (20.6) |
| Continued at discharge | 32 (7.8) | 29 (10.4) | 2 (0.8) | 5 (3.3) | 34 (23.5) | 102 (8.3) |
| Stopped | 49 (11.9) | 27 (9.6) | 19 (7.7) | 6 (4.0) | 19 (13.1) | 120 (9.7) |
| Empirical AB regimen was | ||||||
| De-escalated | 227 (55.1) | 176 (62.9) | 142 (57.3) | 95 (63.3) | 56 (38.6) | 696 (56.4) |
| Escalated | 84 (20.4) | 45 (16.1) | 43 (17.3) | 29 (19.3) | 24 (16.5) | 225 (18.2) |
| Changed-equal spectrum | 19 (4.6) | 3 (1.1) | 41 (16.5) | 15 (10.0) | 12 (8.3) | 90 (7.3) |
| Unchangedb | 82 (19.9) | 56 (20.0) | 22 (8.9) | 11 (7.3) | 53 (36.6) | 224 (18.1) |
| Time to change of first AB regimen (n = 1011) | ||||||
| Mean (95% CI)c | 4.0 (3.7, 4.2) | 3.9 (3.7, 4.1) | 3.0 (2.7, 3.3) | 3.4 (3.1, 3.8) | 3.5 (3.1, 3.9) | 3.6 (3.5, 3.8) |
| Number of treatment regimens through admission | ||||||
| 1 | 41 (9.9) | 33 (11.8) | 5 (2.0) | 6 (4.0) | 34 (23.5) | 119 (9.6) |
| 2 | 245 (59.5) | 187 (66.8) | 86 (34.7) | 77 (51.3) | 75 (51.7) | 670 (54.3) |
| 3 | 92 (22.3) | 43 (15.4) | 122 (49.2) | 44 (29.3) | 29 (20.0) | 330 (26.7) |
| > 3 | 34 (8.3) | 17 (6.1) | 35 (14.1) | 23 (15.3) | 7 (4.8) | 116 (9.4) |
| Oral AB given | ||||||
| Yes | 326 (79.1) | 243 (86.8) | 204 (82.3) | 136 (90.7) | 135 (93.1) | 1044 (84.5) |
| No | 86 (20.9) | 37 (13.2) | 44 (17.7) | 14 (9.3) | 10 (6.9) | 191 (15.5) |
| Mean first day (95% CI) | 4.2 (3.9, 4.5) | 3.6 (3.3, 3.8) | 5.1 (4.6, 5.5) | 4.8 (4.3, 5.3) | 2.7 (2.3, 3.1) | 4.1 (3.9, 4.3) |
| First change of AB regimen | ||||||
| During admission | 232 (56.3) | 167 (59.6) | 205 (82.7) | 82 (54.7) | 73 (50.3) | 759 (61.5) |
| At discharge | 99 (24.0) | 57 (20.4) | 22 (8.9) | 57 (38.0) | 19 (13.1) | 254 (20.6) |
| Continued at discharge | 32 (7.8) | 29 (10.4) | 2 (0.8) | 5 (3.3) | 34 (23.5) | 102 (8.3) |
| Stopped | 49 (11.9) | 27 (9.6) | 19 (7.7) | 6 (4.0) | 19 (13.1) | 120 (9.7) |
| Antibiotics prescribed at discharge | ||||||
| Yes | 296 (71.8) | 214 (76.4) | 193 (77.8) | 139 (92.7) | 114 (78.6) | 956 (77.4) |
| No | 116 (28.2) | 66 (23.6) | 55 (22.2) | 11 (7.3) | 31 (21.4) | 279 (22.6) |
| Days of AB treatment | ||||||
| Mean (95% CI)d | 10.2 (9.7, 10.6) | 10.0 (9.6, 10.5) | 11.5 (10.8, 12.2) | 12.5 (11.6, 13.4) | 9.3 (8.6, 10.1) | 10.6 (10.3, 10.9) |
| In-hospital | 6.3 (5.9, 6.7) | 6.0 (5.7, 6.4) | 6.6 (6.1, 7.1) | 6.0 (5.3, 6.6) | 5.3 (4.8, 5.8) | 6.2 (5.9, 6.4) |
| After dischargee | 5.5 (5.2, 5.8) | 5.2 (4.9, 5.6) | 6.3 (5.8, 6.8) | 7.1 (6.4, 7.7) | 4.9 (4.5, 5.3) | 5.8 (5.6, 6.0) |
a Measured as match between initial grouped indication for treatment and grouped discharge diagnosis
b "Unchanged" includes patients where discontinuation of antibiotics was the only change
c Does not include patients who did not change initial antibiotic regimen (stop was only change)
d Does not include 40 patients where lenght of prescription treatment after discharge not stated in the discharge letter
e Does not include 40 patients where length of prescription treatment was not stated in the discharge letter and 5 patients where length of prescriptions treatment was longer than 30 days