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Table 3 Antibiotic (AB) prescribing in hospitals – process measures

From: Identifying targets for antibiotic stewardship interventions through analysis of the antibiotic prescribing process in hospitals - a multicentre observational cohort study

  LRTI (n = 412) n (%) COPD ex (n = 280) n (%) Sepsis (n = 248) n (%) SSTI (n = 150) n (%) UTI (n = 145) n (%) Total (N = 1235) n (%)
AB initiated
 Emergency room 320 (77.7) 244 (87.1) 240 (96.8) 135 (90.0) 94 (64.8) 1033 (83.6)
 Ward 92 (22.3) 36 (12.9) 8 (3.2) 15 (10.0) 51 (35.2) 202 (16.4)
Adherence to guideline
 Yes 280 (68.0) 177 (63.2) 151 (60.9) 90 (60.0) 80 (55.2) 778 (63.0)
 No 132 (32.0) 103 (36.8) 97 (39.1) 60 (40.0) 65 (44.8) 457 (37.0)
Accuracy between indication for AB-treatment and discharge infection diagnosesa
 Yes 331 (80.3) 255 (91.1) 103 (41.5) 143 (95.3) 122 (84.1) 954 (77.3)
 No 81 (19.7) 25 (8.9) 145 (58.5) 7 (4.7) 23 (15.9) 281 (22.8)
Empirical AB regimen was
 Changed during admission 232 (56.3) 167 (59.6) 205 (82.7) 82 (54.7) 73 (50.3) 759 (61.4)
 Changed at discharge 99 (24.0) 57 (20.4) 22 (8.9) 57 (38.0) 19 (13.1) 254 (20.6)
 Continued at discharge 32 (7.8) 29 (10.4) 2 (0.8) 5 (3.3) 34 (23.5) 102 (8.3)
 Stopped 49 (11.9) 27 (9.6) 19 (7.7) 6 (4.0) 19 (13.1) 120 (9.7)
Empirical AB regimen was
 De-escalated 227 (55.1) 176 (62.9) 142 (57.3) 95 (63.3) 56 (38.6) 696 (56.4)
 Escalated 84 (20.4) 45 (16.1) 43 (17.3) 29 (19.3) 24 (16.5) 225 (18.2)
 Changed-equal spectrum 19 (4.6) 3 (1.1) 41 (16.5) 15 (10.0) 12 (8.3) 90 (7.3)
 Unchangedb 82 (19.9) 56 (20.0) 22 (8.9) 11 (7.3) 53 (36.6) 224 (18.1)
Time to change of first AB regimen (n = 1011)
 Mean (95% CI)c 4.0 (3.7, 4.2) 3.9 (3.7, 4.1) 3.0 (2.7, 3.3) 3.4 (3.1, 3.8) 3.5 (3.1, 3.9) 3.6 (3.5, 3.8)
Number of treatment regimens through admission
 1 41 (9.9) 33 (11.8) 5 (2.0) 6 (4.0) 34 (23.5) 119 (9.6)
 2 245 (59.5) 187 (66.8) 86 (34.7) 77 (51.3) 75 (51.7) 670 (54.3)
 3 92 (22.3) 43 (15.4) 122 (49.2) 44 (29.3) 29 (20.0) 330 (26.7)
  > 3 34 (8.3) 17 (6.1) 35 (14.1) 23 (15.3) 7 (4.8) 116 (9.4)
Oral AB given
 Yes 326 (79.1) 243 (86.8) 204 (82.3) 136 (90.7) 135 (93.1) 1044 (84.5)
 No 86 (20.9) 37 (13.2) 44 (17.7) 14 (9.3) 10 (6.9) 191 (15.5)
 Mean first day (95% CI) 4.2 (3.9, 4.5) 3.6 (3.3, 3.8) 5.1 (4.6, 5.5) 4.8 (4.3, 5.3) 2.7 (2.3, 3.1) 4.1 (3.9, 4.3)
First change of AB regimen
 During admission 232 (56.3) 167 (59.6) 205 (82.7) 82 (54.7) 73 (50.3) 759 (61.5)
 At discharge 99 (24.0) 57 (20.4) 22 (8.9) 57 (38.0) 19 (13.1) 254 (20.6)
 Continued at discharge 32 (7.8) 29 (10.4) 2 (0.8) 5 (3.3) 34 (23.5) 102 (8.3)
 Stopped 49 (11.9) 27 (9.6) 19 (7.7) 6 (4.0) 19 (13.1) 120 (9.7)
Antibiotics prescribed at discharge
 Yes 296 (71.8) 214 (76.4) 193 (77.8) 139 (92.7) 114 (78.6) 956 (77.4)
 No 116 (28.2) 66 (23.6) 55 (22.2) 11 (7.3) 31 (21.4) 279 (22.6)
Days of AB treatment
 Mean (95% CI)d 10.2 (9.7, 10.6) 10.0 (9.6, 10.5) 11.5 (10.8, 12.2) 12.5 (11.6, 13.4) 9.3 (8.6, 10.1) 10.6 (10.3, 10.9)
 In-hospital 6.3 (5.9, 6.7) 6.0 (5.7, 6.4) 6.6 (6.1, 7.1) 6.0 (5.3, 6.6) 5.3 (4.8, 5.8) 6.2 (5.9, 6.4)
 After dischargee 5.5 (5.2, 5.8) 5.2 (4.9, 5.6) 6.3 (5.8, 6.8) 7.1 (6.4, 7.7) 4.9 (4.5, 5.3) 5.8 (5.6, 6.0)
  1. a Measured as match between initial grouped indication for treatment and grouped discharge diagnosis
  2. b "Unchanged" includes patients where discontinuation of antibiotics was the only change
  3. c Does not include patients who did not change initial antibiotic regimen (stop was only change)
  4. d Does not include 40 patients where lenght of prescription treatment after discharge not stated in the discharge letter
  5. e Does not include 40 patients where length of prescription treatment was not stated in the discharge letter and 5 patients where length of prescriptions treatment was longer than 30 days