24 - Antibiotic Use in Hospital Emergency Departments and Observation Settings from 2012-2018 in a Large Cohort of U.S. Hospitals

Background: While discharge antibiotic prescriptions from emergency department (ED) visits have been reported, systemic antibiotic use during ED and hospital observation (OBS) visits have not been well assessed.  We conducted a descriptive analysis of antibiotic use in these settings.

Methods: We identified ED and OBS visits not resulting in hospitalization, and systemic antibiotics administration charges during these visits from January 2012-December 2018 using the Premier Healthcare Database, representing at least 600 hospitals annually. Antibiotics prescribed after discharge were excluded. We reported the proportion of visits with antibiotic use, and described antibiotic use by class, agent and route stratified by location. We also examined trends in antibiotic use over time using a multivariable logistic model.

Results: We assessed 161,291,011 ED visits and 15,660,062 OBS visits from 2012-2018. Systemic antibiotics were identified in 9.0% of ED visits and 25.2% of OBS visits. Parenteral (IV) antibiotics were received in a high proportion of ED and OBS visits in which a systemic antibiotic was received (52.6% and 87.6% respectively).  In the ED, 3^rd/4^th generation cephalosporins were the most commonly identified (32.7%) while in the OBS, 1^st/2^nd generation cephalosporins were most commonly identified (38.9%), Fig. 1. The most common agents in the ED were ceftriaxone, azithromycin, and cephalexin while the most common agents in the OBS were cefazolin, ceftriaxone, and levofloxacin. Any systemic antibiotic use in EDs declined slightly from 2012-2018 (9.2%-8.9%, p< 0.0001) while use in OBS settings saw the largest increase from 2017- 2018 (25.4%-30.4%, p< 0.0001), Fig. 2. Fluoroquinolone use decreased in both ED (41.3%) and OBS (31.2%) (both p< 0.0001) beginning in years 2012 and 2016 respectively.Figure 1: Antibiotic use in emergency departments and observation settings by antibiotic class, Premier Healthcare Database Hospitals, 2012-2018
Figure 2: Overall antibiotic use in emergency departments and observation settings by year, Premier Healthcare Database Hospitals, 2012-2018


Conclusion: Hospital ED and OBS settings are uniquely positioned to improve appropriate antibiotic use across the spectrum of healthcare. Frequent use of IV antibiotics and recent increases in antibiotic use in observation settings call for evaluation of appropriateness of their use and presence of transition-of-care process. Further evaluation of diagnoses to evaluate the appropriateness of IV administration may highlight additional opportunities for optimizing prescribing practices.

Presenting Author(s)

• 

  Leigh Ellyn Preston, DrPh, MPH

  Public Health Fellow
  DHQP, CDC
  Atlanta, GA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides Slides and Audio

Co-Author(s)

• 

  James Baggs, PhD

  Epidemiologist
  CDC
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SK

  Sarah Kabbani

  Centers for Disease Control and Prevention

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MN

  Melinda M. Neuhauser, PharmD, MPH

  Pharmacist and Acute Care Lead
  Centers for Disease Control and Prevention
  Chicago, Illinois

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Laura M. King, MPH

  Scientific Data Analyst
  Centers for Disease Control and Prevention

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Sujan Reddy, MD, MSc

  Medical Director of CDC’s Prevention Epicenter Program
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• KH

  Kelly M. Hatfield, MSPH

  Epidemiologist
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• HW

  Hannah Wolford, MSPH

  Scientific Data Analyst
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Sophia Kazakova, MD, MPH, PhD

  Epidemiologist
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• NM

  Natalie McCarthy, MPH

  Epidemiologist
  CDC
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• CM

  Clifford McDonald, MD

  Associate Director for Science
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.