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Identifying Outliers of Antibiotic Usage in Prevalence Studies on Nosocomial Infections

Published online by Cambridge University Press:  02 January 2015

Petra Gastmeier ,
Dorit Sohr ,
Dietmar Forster ,
Gabriele Schulgen ,
Martin Schumacher ,
Franz Daschner  and
Henning Rüden
Petra Gastmeier*
Affiliation:
Institute of Hygiene, Free University of Berlin, Berlin, Germany
Dorit Sohr
Affiliation:
Institute of Hygiene, Free University of Berlin, Berlin, Germany
Dietmar Forster
Affiliation:
Institute of Environmental Medicine and Hospital Hygiene, Albert Ludwigs University, Freiburg, Germany
Gabriele Schulgen
Affiliation:
Institute of Medical Biometry and Medical Informatics, Albert Ludwigs University, Freiburg, Germany
Martin Schumacher
Affiliation:
Institute of Medical Biometry and Medical Informatics, Albert Ludwigs University, Freiburg, Germany
Franz Daschner
Affiliation:
Institute of Environmental Medicine and Hospital Hygiene, Albert Ludwigs University, Freiburg, Germany
Henning Rüden
Affiliation:
Institute of Hygiene, Free University of Berlin, Berlin, Germany
*
Institute of Hygiene, Free University Berlin, Heubnerweg 6, 14 059 Berlin, Germany
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Abstract

Objective:

To investigate whether the correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in each hospital department, described by Pearson's correlation coefficient (ρ) for binary data as a measure for adequate use of antibiotics, is an appropriate quality indicator.

Design:

Comparison of the results of repeated prevalence studies in different hospitals with the data of a national prevalence study, comparing the hospital (ρ) and reference (ρNIDHP[Nosokomiale Infektionen in Deutschland: Erfassung und Prävention]) correlation coefficients for “use of antibiotics/ presence of infections.”

Setting:

The data of 5,377 surgical patients were separated from the total data of a national prevalence study in 72 representative hospitals to create a reference correlation coefficient (ρNIDEP) with a reference range. Nine additional prevalence studies, involving a total of 4,984 patients, were repeatedly performed in the surgical departments of 8 other hospitals during a 12-month period, whereby the correlation coefficients ρn for every prevalence investigation were determined.

Results:

In the national prevalence study, 15.3% of the surgical patients received antibiotics on the study day. Surgical patients had a 3.8% prevalence of nosocomial infections and a 7.0% prevalence of community-acquired infections. Pearson's correlation coefficient ρNIDEP for correlation between patients' binary data use of antibiotics and presence of infection was 0.62. To compare the correlation coefficient of each department with the appropriate reference range, the coefficients of the single departments were plotted against the number of patients; in these plots, three lines indicated the value ρNIDEP and the upper and lower reference ranges, depending on the number of patients. Seven of eight surgical departments investigated during the repeated prevalence studies were found to be within the reference range, near the reference value, in the majority of prevalence studies; only one of the departments was identified as an outlier as regards antibiotic use.

Conclusion:

The correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in hospitals or departments, as described by Pearson's correlation coefficient ρ for binary data with a definitive reference range depending on the number of patients, is useful for quality management in identifying the overall necessity for evaluating the indications for antibiotic use in one's own hospital.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 5 , May 2000 , pp. 324 - 328
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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