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Variation in antibiotic use across intensive care units (ICU): A population-based cohort study in Ontario, Canada

Published online by Cambridge University Press:  16 June 2020

Erika Y. Lee ,
Michael E. Detsky ,
Jin Ma ,
Chaim M. Bell  and
Andrew M. Morris
Erika Y. Lee
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Michael E. Detsky
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Sinai Health System, Toronto, Ontario, Canada Interdepartmental Division of Critical Care Medicine, Sinai Health System, Toronto, Ontario, Canada
Jin Ma
Affiliation:
Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
Chaim M. Bell
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Sinai Health System, Toronto, Ontario, Canada Department of Medicine, University Health Network, Toronto, Ontario, Canada
Andrew M. Morris*
Affiliation:
Department of Medicine, University of Toronto, Toronto, Ontario, Canada Department of Medicine, Sinai Health System, Toronto, Ontario, Canada Department of Medicine, University Health Network, Toronto, Ontario, Canada
*
Author for correspondence: Andrew M. Morris, E-mail: Andrew.Morris@sinaihealthsystem.ca
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Abstract

Objectives:

Antibiotics are commonly used in intensive care units (ICUs), yet differences in antibiotic use across ICUs are unknown. Herein, we studied antibiotic use across ICUs and examined factors that contributed to variation.

Methods:

We conducted a retrospective cohort study using data from Ontario’s Critical Care Information System (CCIS), which included 201 adult ICUs and 2,013,397 patient days from January 2012 to June 2016. Antibiotic use was measured in days of therapy (DOT) per 1,000 patient days. ICU factors included ability to provide ventilator support (level 3) or not (level 2), ICU type (medical-surgical or other), and academic status. Patient factors included severity of illness using multiple-organ dysfunction score (MODS), ventilatory support, and central venous catheter (CVC) use. We analyzed the effect of these factors on variation in antibiotic use.

Results:

Overall, 269,351 patients (56%) received antibiotics during their ICU stay. The mean antibiotic use was 624 (range 3–1460) DOT per 1,000 patient days. Antibiotic use was significantly higher in medical-surgical ICUs compared to other ICUs (697 vs 410 DOT per 1,000 patient days; P < .0001) and in level 3 ICUs compared to level 2 ICUs (751 vs 513 DOT per 1,000 patient days; P < .0001). Higher antibiotic use was associated with higher severity of illness and intensity of treatment. ICU and patient factors explained 47% of the variation in antibiotic use across ICUs.

Conclusions:

Antibiotic use varies widely across ICUs, which is partially associated with ICUs and patient characteristics. These differences highlight the importance of antimicrobial stewardship to ensure appropriate use of antibiotics in ICU patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 9 , September 2020 , pp. 1035 - 1041
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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