| Related Articles |
Trends in Antibiotic Use and Nosocomial Pathogens in Hospitalized Veterans with Pneumonia at 128 Medical Centers, 2006-2010.
Clin Infect Dis. 2015 Jul 29;
Authors: Jones BE, Jones M, Huttner B, Stoddard G, Brown KA, Stevens V, Greene T, Sauer B, Madaras-Kelly K, Rubin M, Goetz MB, Samore M
Abstract
BACKGROUND: In 2005, pneumonia practice guidelines recommended broad-spectrum antibiotics for patients with risk factors for nosocomial pathogens. The impact of these recommendations on providers' ability to match treatment with nosocomial pathogens is unknown.
METHODS: Among hospitalizations with a principal diagnosis of pneumonia at 128 VA medical centers from 2006 through 2010, we measured annual trends in antibiotic selection, initial blood or respiratory cultures positive for MRSA, Pseudomonas aeruginosa, and Acinetobacter species, and alignment between antibiotic coverage and culture results for MRSA and Pseudomonas aeruginosa by calculating sensitivity, specificity, and diagnostic odds ratio [DOR] using a 2x2 contingency table.
RESULTS: Of 95,511 hospitalizations for pneumonia, initial use of vancomycin increased from 16% in 2006 to 31% in 2010, and piperacillin-tazobactam increased from 16% to 27%, while there was a decrease in both ceftriaxone (39% to 33%) and azithromycin (39% to 36%) (p<0.001 for all). The proportion of culture-positive MRSA hospitalizations decreased (2.5% to 2.0%, p<0.001); no change was seen for Pseudomonas aeruginosa (1.9% to 2.0%, p=0.14) or Acinetobacter spp. (0.2% to 0.2%, p=0.17). For both MRSA and Pseudomonas aeruginosa, sensitivity increased (46% to 65% and 54% to 63%, p<0.001) and specificity decreased (85% to 69% and 76% to 68%, p<0.001), with no significant changes in DOR (4.6 to 4.1, p=0.57 and 3.7 to 3.2, p=0.95).
CONCLUSIONS: Between 2006 and 2010, we found a substantial increase in the use of broad-spectrum antibiotics for pneumonia despite no increase in nosocomial pathogens. Providers' ability to accurately match antibiotic coverage to nosocomial pathogens remains low.
PMID: 26223995 [PubMed - as supplied by publisher]