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Variability in Antimicrobial Use Among Hospitals Participating in the Canadian Nosocomial Infection Surveillance Program

Published online by Cambridge University Press:  02 November 2020

Wallis Rudnick
Affiliation:
Public Health Agency of Canada
Linda Pelude
Affiliation:
Public Health Agency of Canada
Michelle Science
Affiliation:
The Hospital for Sick Children
Daniel J.G. Thirion
Affiliation:
Université de Montréal and McGill University Health Centre
Jeannette Comeau
Affiliation:
Dalhousie University
Bruce Dalton
Affiliation:
Alberta Health Services
Johan Delport
Affiliation:
London Health Sciences Centre
Rita Dhami
Affiliation:
London Health Sciences Centre and University of Waterloo
Joanne Embree
Affiliation:
University of Manitoba and Shared Health Manitoba
Yannick Émond
Affiliation:
Maisonneuve-Rosemont Hospital
Gerald Evans
Affiliation:
Kingston Health Sciences Centre
Charles Frenette
Affiliation:
McGill University Health Center
Susan Fryters
Affiliation:
Alberta Health Services
Greg German
Affiliation:
Health PEI
Jennifer Grant
Affiliation:
University of British Columbia
Jennifer Happe
Affiliation:
Alberta Health Services
Kevin Katz
Affiliation:
North York General Hospital
Pamela Kibsey
Affiliation:
Royal Jubilee Hospital
Justin Kosar
Affiliation:
Saskatchewan Health Authority
Joanne Langley
Affiliation:
IWK Health Centre and Dalhousie University
Bonita E. Lee
Affiliation:
Stollery Children’s Hospital and University of Alberta
Marie-Astrid Lefebvre
Affiliation:
Montreal Children’s Hospital, McGill University Health Centre
Jerome Leis
Affiliation:
University of Toronto
Susan McKenna
Affiliation:
Kingston Health Sciences Centre
Allison McGeer
Affiliation:
Sinai Health System and University of Toronto
Heather Neville
Affiliation:
Nova Scotia Health Authority
Anada Silva
Affiliation:
Public Health Agency of Canada
Andrew Simor
Affiliation:
Sunnybrook Health Sciences Center
Kathryn Slayter
Affiliation:
IWK Health Centre and Dalhousie University
Kathryn Suh
Affiliation:
The Ottawa Hospital
Alena Tse-Chang
Affiliation:
University of Alberta
Karl Weiss
Affiliation:
SMBD-Jewish General Hospital
John Conly
Affiliation:
Foothills Medical Centre and University of Calgary
CNISP PHAC
Affiliation:
Public Health Agency of Canada
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Abstract

Background: The association between antimicrobial use (AMU) and emergence of antimicrobial resistance is well documented. The Canadian Nosocomial Infection Surveillance Program (CNISP) has conducted sentinel surveillance of AMU at participating Canadian hospitals since 2009 resulting in the largest pan-Canadian hospital database of dispensed antimicrobials. Objectives: Describe interhospital variability of AMU across Canada. Methods: Hospitals submit annual AMU data based on patient days (PD). Antimicrobials were measured in defined daily doses (DDD) for adults using the WHO Anatomical Therapeutic Chemical (ATC) system. The AMU data among pediatric patients have been available since 2017 using days of therapy (DOT). Surveillance includes systemic antibacterial agents (J01 ATC codes), oral metronidazole, and oral vancomycin. AMU was assessed using quintiles, interquartile ranges (IQR), and relative IQRs (upper- and lower-quartile values divided by the median). Results: Between 2009 and 2018, 20–26 hospitals participated in adult surveillance each year (35 teaching hospitals and 3 nonteaching hospitals participated in ≥1 year). Over this period, overall AMU decreased by 13% at participating adult hospitals from 645 to 560 DDD per 1,000 PD. AMU varied substantially between hospitals, but this variability decreased over time (Fig. 1). In 2009, the IQRs for overall AMU spanned 309 DDD per 1,000 PD, and in 2018 it spanned only 103 DDD per 1,000 PD. This decrease in variability was due to large decreases in use among hospitals with high use in 2009–2010. Among hospitals in the highest use quintile in 2009–2010, AMU decreased, on average, 44 DDD per 1,000 PD each year. Among hospitals in the lowest use quintile in 2009–2010, AMU increased, on average, 6 DDD per 1,000 PD each year. In 2018, antibiotics with the largest absolute IQR variability were cefazolin (61–113 DDD per 1,000 PD), piperacillin-tazobactam (32–64 DDD per 1,000 PD), and vancomycin (24–49 DDD per 1,000 PD). Among antibiotics with ≥1 DDD per 1,000 PD, antibiotics with the largest relative IQR variability were tobramycin (0.3–6 DDD per 1,000 PD), cefadroxil (0.08–9 DDD per 1,000 PD), and linezolid (0.2–3 DDD per 1,000 PD). In 2018, the IQR for overall pediatric AMU (n = 7 teaching hospitals) was 426–581 DOT per 1,000 PD. Antibiotics with the largest IQRs were vancomycin (0.6–58 DOT per 1,000 PD), cefazolin (33–88 DOT per 1,000 PD), and tobramycin (3–57 DOT per 1,000 PD). Among antibiotics with ≥1 DOT per 1,000 PD in 2018, antibiotics with the largest relative IQRs were tobramycin (3–57 DOT per 1,000 PD), cefuroxime (1–6 DOT per 1,000 PD), and amoxicillin (8–42 DOT per 1,000 PD). Conclusions: There is wide variation in overall antibiotic use across hospitals. Variation between AMU at adult hospitals has decreased between 2009 and 2018; in 2018, antibiotics with the largest IQRs were cefazolin and piperacillin-tazobactam. Benchmarking AMU is crucial for informing antimicrobial stewardship efforts.

Funding: CNISP is funded by the Public Health Agency of Canada.

Disclosures: Allison McGeer reports funds to her institution from Pfizer and Merck for projects for which she is the principal investigator. She also reports consulting fees from Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.

Type
Poster Presentations
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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