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5 results

  • 74 - Antimicrobial Overview

  • from Part V - Overview of Antibiotics
    • By Conan MacDougall, Assistant Professor of Clinical Pharmacy, University of California, San Francisco School of Pharmacy, San Francisco, CA, B. Joseph Guglielmo, Professor, and Chair of Clinical Pharmacy, Department of Clinical Pharmacy, University of California, San Francisco School of Pharmacy, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Book:
    Emergency Management of Infectious Diseases
    Published online:
    15 December 2009
    Print publication:
    30 June 2008, pp 495-514

  • Summary

    INTRODUCTION – PRINCIPLES OF ANTIMICROBIAL USE

    Pharmacokinetics and Pharmacodynamics

    Many factors affect the choice of an antimicrobial agent in the acute care setting. Selection of an agent with in vitro activity against the infecting pathogen is necessary but not sufficient. Pharmacokinetic (distribution of the drug in the body) and pharmacodynamic (effect of the drug on its target) factors must also be taken into account. The most important pharmacokinetic consideration is the concentration of the drug at the site of infection. The physicochemical properties of antimicrobials determine their distribution throughout the body, and these properties may be unfavorable for the penetration of certain tissue compartments.

    Sites of particular concern for the adequate penetration of antimicrobials include bone, compartments of the eye, and the central nervous system. Additionally, abscess cavities are poorly penetrated and should be drained regardless of whether systemic antimicrobial therapy is to be used. Even treatment of pulmonary and urinary tract infections depends on site-specific penetration, and recommendations for standard therapies reflect this. Thus, clinicians should rely on standard therapy or use alternative drugs that are documented to achieve effective concentrations at the site of interest. Unfortunately, data as to the relative penetration of different drugs may be lacking, although predictions based on physicochemical characteristics (e.g., protein binding) can be made.

    An important pharmacodynamic distinction is whether a drug's activity is bactericidal or bacteriostatic.

  • Variability in Rates of Use of Antibacterials Among 130 US Hospitals and Risk-Adjustment Models for Interhospital Comparison

  • Conan MacDougall, Ronald E. Polk
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 29 / Issue 3 / March 2008
    Published online by Cambridge University Press:
    02 January 2015, pp. 203-211
    Print publication:
    March 2008
  • Objective.

    To describe variability in rates of antibacterial use in a large sample of US hospitals and to create risk-adjusted models for interhospital comparison.

    Methods.

    We retrospectively surveyed the use of 87 antibacterial agents on the basis of electronic claims data from 130 medical-surgical hospitals in the United States for the period August 2002 to July 2003; these records represented 1,798,084 adult inpatients. Hospitals were assigned randomly to the derivation data set (65 hospitals) or the validation data set (65 hospitals). Multivariable models predicting rates of antibacterial use were created using the derivation data set. These models were then used to predict rates of antibacterial use in the validation data set, which was compared with observed rates of antibacterial use. Rates of antibacterial use was measured in days of therapy per 1,000 patient-days.

    Results.

    Across the surveyed hospitals, a mean of 59.3% of patients received at least 1 dose of an antimicrobial agent during hospitalization (range for individual hospitals, 44.4%-73.6%). The mean total rate of antibacterial use was 789.8 days of therapy per 1,000 patient-days (range, 454.4-1,153.4). The best model for the total rate of antibacterial use explained 31% of the variance in rates of antibacterial use and included the number of hospital beds, the number of days in the intensive care unit per 1,000 patient-days, the number of surgeries per 1,000 discharges, and the number of cases of pneumonia, bacteremia, and urinary tract infection per 1,000 discharges. Five hospitals in the validation data set were identified as having outlier rates on the basis of observed antibacterial use greater than the upper bound of the 90% prediction interval for predicted antibacterial use in that hospital.

    Conclusion.

    Most adult inpatients receive antimicrobial agents during their hospitalization, but there is substantial variability between hospitals in the volume of antibacterials used. Risk-adjusted models can explain a significant proportion of this variation and allow for comparisons between hospitals for benchmarking purposes.