eprintid: 10140968
rev_number: 21
eprint_status: archive
userid: 608
dir: disk0/10/14/09/68
datestamp: 2022-01-07 16:15:03
lastmod: 2022-01-07 16:15:03
status_changed: 2022-01-07 16:15:03
type: article
metadata_visibility: show
creators_name: Budgell, EP
creators_name: Davies, T
creators_name: Donker, T
creators_name: Hopkins, S
creators_name: Wyllie, D
creators_name: Peto, TEA
creators_name: Gill, M
creators_name: Llewelyn, MJ
creators_name: Walker, AS
title: Impact of hospital antibiotic use on patient-level risk of death among 36,124,372 acute and medical admissions in England
ispublished: inpress
divisions: UCL
divisions: B02
divisions: D65
divisions: J38
keywords: Anti-Bacterial Agents, Antimicrobial Stewardship, Electronic Health Records, Mortality, Secondary care
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
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 (≥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.
date: 2021-12-25
date_type: published
official_url: https://doi.org/10.1016/j.jinf.2021.12.029
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1911660
doi: 10.1016/j.jinf.2021.12.029
pii: S0163-4453(21)00648-4
lyricists_name: Walker, Ann
lyricists_id: ASWAL40
actors_name: Barczynska, Patrycja
actors_id: PBARC91
actors_role: owner
full_text_status: public
publication: Journal of Infection
event_location: England
issn: 1532-2742
citation:        Budgell, EP;    Davies, T;    Donker, T;    Hopkins, S;    Wyllie, D;    Peto, TEA;    Gill, M;         ... Walker, AS; + view all <#>        Budgell, EP;  Davies, T;  Donker, T;  Hopkins, S;  Wyllie, D;  Peto, TEA;  Gill, M;  Llewelyn, MJ;  Walker, AS;   - view fewer <#>    (2021)    Impact of hospital antibiotic use on patient-level risk of death among 36,124,372 acute and medical admissions in England.                   Journal of Infection        10.1016/j.jinf.2021.12.029 <https://doi.org/10.1016/j.jinf.2021.12.029>.    (In press).    Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10140968/1/Walker_1-s2.0-S0163445321006484-main.pdf