Impact of antibiotic use on patient-level risk of death in 36 million hospital admissions in England

Eric P. Budgell*, Timothy J. Davies, Tjibbe Donker, Susan Hopkins, David H. Wyllie, Tim E.A. Peto, Martin J. Gill, Martin J. Llewelyn, A. Sarah Walker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)311-320
Number of pages10
JournalJournal of Infection
Volume84
Issue number3
DOIs
Publication statusPublished - Mar 2022

Bibliographical note

Funding Information:
This work was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0514 20015 ), and by Antibiotic Research UK (ANTRUK) grant number ANTSRG 02/2018 . ASW is supported by the NIHR Biomedical Research center, Oxford. ASW and TEAP are NIHR Senior Investigators. The views expressed in this publication are those of the author(s) and not necessarily those of ANTRUK, the NHS, the NIHR, or the Department of Health.

Funding Information:
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf: EPB declares a grant from Antibiotic Research UK (ANTRUK) during the conduct of the study (grant number ANTSRG 02/2018). ASW reports grants from National Institutes of Health Research, UK, during the conduct of the study. TEAP reports grants from Wellcome Trust, the Medical Research Council, BBRC, Bill and Melinda Gates Foundation, and NIHR, outside the submitted work. All authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; all authors declare no other relationships or activities that could appear to have influenced the submitted work.

Funding Information:
This work was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0514–20,015), and by Antibiotic Research UK (ANTRUK) grant number ANTSRG 02/2018. ASW is supported by the NIHR Biomedical Research Centre, Oxford. ASW and TEAP are NIHR Senior Investigators. The views expressed in this publication are those of the author(s) and not necessarily those of ANTRUK, the NHS, the NIHR, or the Department of Health. The funders had no role in the study design, data collection, analysis, interpretation of results, writing of the manuscript, or the decision to publish.

Publisher Copyright:
© 2021

Keywords

  • Anti-bacterial agents
  • Antimicrobial stewardship
  • Electronic health records
  • Mortality
  • Secondary care

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