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Impact of hospital antibiotic use on patient-level risk of death among 36,124,372 acute and medical admissions in England
journal contribution
posted on 2023-06-10, 02:13 authored by Eric P Budgell, Tim Davies, Tjibbe Donker, Susan Hopkins, David Wyllie, Tim E A Peto, Martin Gill, Martin LlewelynMartin Llewelyn, A Sarah WalkerObjectives: Initiatives to curb hospital antibiotic use might be associated with harm from under-treatment. We examined the extent to which variation in hospital antibiotic prescribing is associated with mortality risk in acute/general medicine inpatients. Methods: This ecological analysis examined Hospital Episode Statistics from 36,124,372 acute/general medicine admissions (=16y) to 135 acute hospitals in England, 01/April/2010–31/March/2017. Random-effects meta-regression was used to investigate whether heterogeneity in adjusted 30-day mortality was associated with hospital-level antibiotic use, measured in defined-daily-doses (DDD)/1,000 bed-days. Models also considered DDDs/1,000 admissions and DDDs for narrow-spectrum/broad-spectrum antibiotics, parenteral/oral, and local interpretations of World Health Organization Access, Watch, and Reserve antibiotics. Results: Hospital-level antibiotic DDDs/1,000 bed-days varied 15-fold with comparable variation in broad-spectrum, parenteral, and Reserve antibiotic use. After extensive adjusting for hospital case-mix, the probability of 30-day mortality changed -0.010% (95% CI: -0.064,+0.044) for each increase of 500 hospital-level antibiotic DDDs/1,000 bed-days. Analyses of other metrics of antibiotic use showed no consistent association with mortality risk. Conclusions: We found no evidence that wide variation in hospital antibiotic use is associated with adjusted mortality risk in acute/general medicine inpatients. Using low-prescribing hospitals as benchmarks could help drive safe and substantial reductions in antibiotic consumption of up-to one-third in this population.
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Publication status
- Published
File Version
- Published version
Journal
Journal of InfectionISSN
0163-4453Publisher
ElsevierExternal DOI
Issue
3Volume
84Page range
311-320Department affiliated with
- Global Health and Infection Publications
Full text available
- Yes
Peer reviewed?
- Yes
Legacy Posted Date
2022-01-07First Open Access (FOA) Date
2022-03-07First Compliant Deposit (FCD) Date
2022-03-07Usage metrics
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