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Benchmarking antimicrobial use to antimicrobial resistance: a comparative study of two hospitals using current National Healthcare Safety Network (NHSN) metrics

Published online by Cambridge University Press:  27 January 2025

Carlos A.Q. Santos Open the ORCID record for Carlos A.Q. Santos [Opens in a new window] ,
Sarah Y. Won ,
Ryan Dwyer ,
Caren Perez ,
William E. Trick Open the ORCID record for William E. Trick [Opens in a new window]  and
for the CDC Prevention Epicenters Program
Carlos A.Q. Santos*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, RUSH University Medical Center, Chicago, IL, USA
Sarah Y. Won
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, RUSH University Medical Center, Chicago, IL, USA
Ryan Dwyer
Affiliation:
Department of Pharmacy, RUSH Oak Park Hospital, Oak Park, IL, USA
Caren Perez
Affiliation:
RUSH Digital and Information Services, Chicago, IL, USA
William E. Trick
Affiliation:
Center for Health Equity and Innovation, Cook County Health, Chicago, IL, USA Department of Internal Medicine, RUSH University Medical Center, Chicago, IL, USA
*
Corresponding author: Carlos A.Q. Santos; Email: Carlos_A_Santos@rush.edu
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Abstract

Objective:

We aimed to determine whether benchmarking antimicrobial use (AU) to antimicrobial resistance (AR) using select AU/AR ratios is more informative than AU metrics in isolation.

Design:

We retrospectively measured AU (antimicrobial therapy days per 1,000 days present) and AU/AR ratios (specific antimicrobial therapy days per corresponding AR event) in two hospitals during 2020 through 2022. We then had antimicrobial stewardship committee members evaluate each AU and corresponding AU/AR value and indicate whether they believed it represented potential overuse, appropriate use, or potential underuse of the antimicrobials, or whether they could not provide an assessment.

Setting:

Two acute-care hospitals.

Patients:

Hospitalized patients.

Results:

In semi-annual facility-wide analyses, echinocandins had a median AU/AR ratio of 658.5 therapy days per fluconazole-resistant Candida event in Hospital A, IV vancomycin had a median AU/AR ratio of 114.9 and 108.2 therapy days per methicillin-resistant Staphylococcus aureus event in Hospital A and B, respectively, and linezolid had a median AU/AR ratio of 33.8 and 88.0 therapy days per vancomycin-resistant Enterococcus event in Hospital A and B, respectively. When AU and AU/AR values were evaluated by stewardship committees, more respondents were able to assess antimicrobial use based on AU/AR values compared to AU values. Based on AU/AR ratios, most respondents identified potential overuse of echinocandins and IV vancomycin in Hospital A, and potential overuse of linezolid and IV vancomycin in Hospital B.

Conclusion:

Select AU/AR ratios provided informative metrics to antimicrobial stewardship personnel, which can be used to motivate audits of antimicrobial administration to determine appropriateness.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 8
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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