@article{discovery10140968,
            note = {This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.},
           month = {December},
         journal = {Journal of Infection},
            year = {2021},
           title = {Impact of hospital antibiotic use on patient-level risk of death among 36,124,372 acute and medical admissions in England},
        abstract = {OBJECTIVES: 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 ({$\ge$}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.},
            issn = {1532-2742},
          author = {Budgell, EP and Davies, T and Donker, T and Hopkins, S and Wyllie, D and Peto, TEA and Gill, M and Llewelyn, MJ and Walker, AS},
             url = {https://doi.org/10.1016/j.jinf.2021.12.029},
        keywords = {Anti-Bacterial Agents, Antimicrobial Stewardship, Electronic Health Records, Mortality, Secondary care}
}