Improving Antibiotic Use in Tennessee: The Tennessee Department of Health's Antibiotic Stewardship Collaborative

BACKGROUND:   In 2011, Tennessee had the highest prevalence of inpatient antibiotic usage among 10 Emerging Infection Program states participating in the Healthcare Associated Infections and Antimicrobial Use Prevalence Survey. Recognizing the serious need to improve antibiotic use in hospitals, the Tennessee Department of Health (TDH) in 2013 developed a database for tracking antibiotic use. Due to inadequate technical infrastructure, no facilities in Tennessee currently report antimicrobial use (AU) data to the National Healthcare Safety Network (NHSN) AU module. To assess AU over time, TDH used an interim method to assess antibiotic prescribing habits.

METHODS:  A simple point prevalence survey captured census data and number of patients with an active order for specific antibiotics during a 24 hour period.  Survey data is entered by pharmacists into REDCap; descriptive analysis is performed quarterly using SAS 9.3.

RESULTS:  A total of 16 hospitals completed at least one facility-wide or specific-unit survey during the first quarter of 2014, 17 participated during the second quarter, and 18 during the third quarter. While most contribute quarterly data, one facility enters antibiotic usage every day. Various sized facilities participated with hospital bed size ranging from 30 to 910 beds; the median census per quarter ranged from 99 to 135 patients per day. The overall proportion of patients on any antibiotic across quarters ranged from 48% to 61.7%. Quinolones consistently had the highest antibiotic usage, 16.3% for Q1 and 15% for Q2 and Q3, plus exhibited the greatest variability within each quarter. Vancomycin IV proportion remained steady, while 3^rd generation cephalosporin and carbapenem use decreased quarterly from 12.5% to 8.0% and 4.7% to 2.2% respectively. Antibiotic use varied across similar sized hospitals, especially for quinolones. Hospitals receive facility specific reports plus de-identified results of other facilities for comparison purposes.

CONCLUSIONS:  TDH uses the reports as an educational opportunity for pharmacists and clinicians regarding appropriate prescribing, anticipating a reduction in unnecessary antibiotic use. The survey will be repeated at least quarterly in participating facilities and as more data is collected, TDH expects to assist facilities in benchmarking their antibiotic usage. Therefore, TDH can monitor antimicrobial use trends over time and assist high-use facilities with interventions. With the survey, TDH also hopes to improve antimicrobial stewardship among Tennessee hospitals.