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Infection and Antibiotic Use in a Community Hospital, 1971-1990

Published online by Cambridge University Press:  21 June 2016

Thomas S. Huth  and
John P. Burke
Thomas S. Huth
Affiliation:
Division of Infectious Diseases, Department of Medicine, LDS Hospital, and, The University of Utah School of Medicine, Salt Lake City, Utah.
John P. Burke*
Affiliation:
Division of Infectious Diseases, Department of Medicine, LDS Hospital, and, The University of Utah School of Medicine, Salt Lake City, Utah.
*
Division of Infectious Diseases, LDS Hospital, 8th Ave. and C St., Salt Lake City, UT 84143
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Abstract

Objective:

To determine the prevalence of infections and antibiotic use at a community hospital in 1990 and to compare the results with those from previous surveys in 1971, 1979, and 1984.

Design:

Point prevalence survey.

Setting:

Community teaching hospital.

Participants:

All hospitalized patients, excluding those on the nursery, psychiatry, and short-stay wards.

Intervention:

Medical records were reviewed and a pertinent physical examination was performed on each patient.

Results:

Overall, 46 (20.1%) of 229 patients had infection in 1990. Community-acquired and hospital-acquired infections were present in 26 (11.4%) and 24 (10.5%) of the patients, respectively. The most common site of community-acquired infection was the deep abdomen in 8 (25.8%) of 32 sites, while hospital-acquired infection most frequently involved the lower respiratory tract in 8 (25.0%) of 32 sites. Antimicrobial agents were being administered to 88 (38.4%) of the patients. Cephalosporins (particularly newer, broad-spectrum agents) were the most frequently used antibiotics, comprising 53 (45.3%) of the 117 total antimicrobial prescriptions. seven (18.4%) of the 38 antibiotics used for surgical prophylaxis were given for more than 48 hours. Trend analysis revealed no significant changes in the proportions of patients with community-acquired, hospital-acquired, or total infection over the last 20 years (p=.18, p=.12, and p=.O7, respectively). While the overall use of antibiotics increased p<.ool), the administration of prophylactic perioperative antibiotics for greater than 48 hours decreased p=.009).

Conclusions:

Despite major shifts in factors associated with an increased risk of infection, the overall prevalences of hospital-acquired and community-acquired infections remained remarkably constant during the last 20 years. Although total antibiotic use increased, the duration of surgical prophylaxis decreased and the pattern of use of therapeutic antibiotics also changed with increased use of broad-spectrum agents

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 9 , September 1991 , pp. 525 - 534
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Horan, TC, White, JW, Jarvis, WR, et al. Nosocomial infection surveillance, 1984. MMWR. 1986;35(suppl 1SS):17SS–29SS.Google ScholarPubMed
2. Haley, RW, Culver, DW, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159–167.CrossRefGoogle Scholar
3. Haley, RW, Schaberg, DR, Von Allmen, S, McGowan, JE. Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. J Infect Dis. 1980;141:248–257.CrossRefGoogle ScholarPubMed
4. Keys, TE. Selecting an antibiotic for the hosoital formulary. In: Wenzel, RR ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams and Wilkins; 1987:233–242.Google Scholar
5. Maki, DG, Schuna, AA. A study of antimicrobial misuse in a university hospital. Am J Med Sci. 1978;275:271–282.CrossRefGoogle ScholarPubMed
6. Moody, ML, Burke, JP. Infections and antibiotic use in a large private hospital, January 1971. Arch Intern Med. 1972;130:261–266.CrossRefGoogle Scholar
7. Stevens, GP, Jacobson, JA, Burke, JI? Changing patterns of hospital infections and antibiotic use. Arch Intern Med. 1981;141:587–592.CrossRefGoogle ScholarPubMed
8. Larsen, RA, Curtis, ET, Jacobson, JA, Burke, JI? Trends in infections and antibiotic usage in a community hospital. Am J Infect Control. 1987;15:7–15.CrossRefGoogle Scholar
9. Adler, JL, Burke, JP, Finland, M. Infection and antibiotic usage at Boston City Hospital, January 1970. Arch Intern Med. 1971;127:460–466.CrossRefGoogle ScholarPubMed
10. Kislak, JW, Eickhoff, TC, Finland, ME. Hospital-acquired infections and antibiotic usage in the Boston City Hospital-January, 1964. N Engl J Med. 1964;271:834–835.CrossRefGoogle ScholarPubMed
11. Slama, TG, Sklar, SJ, Misinski, J, Fess, SW. Randomized comparison of cefamandole, cefazolin, cefuroxime prophylaxis in open heart surgery. Antimicrob Agents Chemother. 1986;29:744–747.CrossRefGoogle ScholarPubMed
12. Nelson, RM, Jenson, CB, Peterson, CA, Sanders, BC. Effective use of prophylactic antibiotics in open heart surgery. Arch Surg. 1965;90:731–736.CrossRefGoogle ScholarPubMed
13. Evans, RS, Larsen, RA, Burke, JP, et al. Computer surveillance of hospital-acquired infections and antibiotic use. JAMA. 1986;256:1007–1011.CrossRefGoogle ScholarPubMed
14. Evans, RS, Pestotnik, SL, Burke, JP, Gardner, RM, Larsen, RA, Classen, DC. Reducing the duration of prophylactic antibiotic use through computer monitoring of surgical patients. Drug Intell Clin Pharm, Annals Pharmacother. 1990;24:351–354.Google ScholarPubMed
15. Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther. 1989;31:105–108.Google Scholar
16. The choice of antimicrobial drugs. Med Lett Drugs Ther. 1990;32:41–45.Google Scholar
17. Norris, S, Nightingale, CH, Mandell, GL. Tables of antimicrobial agent pharmacology In: Mandell, GL, Douglas, RG, Bennett, JE, eds. Principles and Practice of Infectious Diseases. 3rd ed. New York, NY: Churchill Livingston; 1990:434–460.Google Scholar
18. Britt, MR, Schleupner, CJ, Matsumiya, S. Severity of underlying disease as a predictor of nosocomial infection. JAMA. 1978;239:1047–1051.CrossRefGoogle ScholarPubMed
19. Brown, SW, Hollander, M. Statistics: A Biomedical Introduction. New York, NY: John Wiley and Sons; 1977.CrossRefGoogle Scholar
20. French, GL, Wong, SL, Cheng, AFB, Donnan, S. Repeated prevalence surveys for monitoring effectiveness of hospital infection control. Lancet. 1989;1021–1023.CrossRefGoogle ScholarPubMed
21. Freeman, J, McGowan, JE. Risk factors for nosocomial infection. J Infect Dis. 1978;138:811–819.CrossRefGoogle ScholarPubMed
22. Maki, DG, Alvarado, CJ, Hassemer, CA, Zilz, MA. Relation of the inanimate hospital environment to endemic nosocomial infection. N Engl J Med. 1982;307:1562–1566.CrossRefGoogle ScholarPubMed
23. Williams, REO. Infection control: the next 10 years. Am J Med. 1981;70:986.Google Scholar
24. Centers for Disease Control. Increase in national hospital discharge survey rates for septicemia-united States, 1979-1987. JAMA. 1990;263:937–938.CrossRefGoogle Scholar
25. Maki, DG. Nosocomial bloodstream infections. Program and Abstracts of the Third International Conference on Nosocomial Infections; Atlanta, Ga; July 30-August 3, 1990.Google Scholar
26. Weber, DJ, Rutala, WA, Samsa, GP. Changing frequencies of nosocomial pathogens in a university hospital. Program and Abstracts of the Third International Conference on Nosocomial Infections; Atlanta, Ga; July 30-August 3, 1990.Google Scholar
27. Jarvis, WR. Nosocomial fungal infections in the United States, National Nosocomial Infection Surveillance System, January 1980-April 1990. Program and Abstracts of the Third International Conference on Nosocomial Infections; Atlanta, Ga; July 30-August 3, 1990.Google Scholar
28. Schaberg, DR. Major trends in nosocomial bacterial pathogens. Program and Abstracts of the Third International Conference on Nosocomial Infections; Atlanta, Ga; July 30-August 3, 1990.Google Scholar
29. Aswapokee, N, Vaithayapicket, S, Heller, R. Pattern of antibiotic use in medical wards of a university hospital, Bangkok, Thailand. Rev Infect Dis. 1990;12:136–141.CrossRefGoogle ScholarPubMed
30. Pestotnik, SL, Evans, RS, Burke, JP, Gardner, RM, Classen, DC. Therapeutic antibiotic monitoring: surveillance using a computerized expert system. Am J Med. 1990;88:43–48.CrossRefGoogle ScholarPubMed
31. DiPiro, JT, Cheung, RPF, Bowden, TA, Mansberger, JA. Single dose systemic antibiotic prophylaxis of surgical wound infections. Am J Surg. 1986;152:552–559.CrossRefGoogle ScholarPubMed
32. Avorn, J. Reduction of incorrect antibiotic dosing through a structured educational order form. Arch Intern Med. 1988;148:1720–1724.CrossRefGoogle ScholarPubMed
33. Woodward, RS, Medoff, G, Smith, MD, Gray, JL. Antibiotic cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital. Am J Med. 1987;83:817–823.CrossRefGoogle Scholar
34. Echols, RM, Kowasky, SE. The use of an antibiotic order form for antibiotic utilization review: influence on physicians' prescribing patterns. /Infect Dis. 1984;150:803–807.CrossRefGoogle ScholarPubMed
35. Kaiser, AB. Drug therapy: antimicrobial prophylaxis in surgery. N Engl J Med. 1986;315:1129–1138.Google ScholarPubMed
36. Hoffman, SA, Moellering, RC. The enterococcus: ‘putting the bug in our ears.’ Ann Intern Med. 1987;106:757–761.CrossRefGoogle Scholar
37. McGowan, JE. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis. 1983;5:1033–1048.CrossRefGoogle ScholarPubMed