BACKGROUND: In 2013, Tennessee Department of Health (TDH) developed a 21-question survey to gather data on antimicrobial use among hospitals in our Antimicrobial Stewardship Collaborative. Data collection began in January 2014 and has been ongoing since. Report packets are sent to participating hospitals quarterly, with summary tables and graphs comparing facilities to themselves over time and how the collaborative is doing that quarter. As of December 2015, only 3 hospitals in Tennessee submit antimicrobial use (AU) data to the National Healthcare Safety Network (NHSN) AU module. While TDH is strongly encouraging participation in this module, TDH is using this survey as an interim method to assess current prescribing habits and determine trends.
METHODS: A simple point prevalence survey captures census data and number of patients with an active order for (not administration of) specific antibiotics during a 24 hour period. Eight quarters of data have been collected since survey implementation. Clinical pharmacists enter survey data into REDCap; descriptive analysis is performed quarterly using SAS 9.4 (SAS Institute, Cary NC).
RESULTS: Each quarter, between 9 and 18 hospitals submitted data. One hospital consistently submits data daily, while the majority submit data quarterly. We are aware of facilities that have made tremendous strides in antimicrobial stewardship (AS); these efforts are reflected in their survey results. We have also observed a seasonal increase in antimicrobial use during the winter quarters, which correlates with influenza like illness (ILI) levels in the data from the Sentinel Provider Network in Tennessee. In particular, 3rd generation cephalosporins had the most pronounced seasonality. In examining trends over all eight quarters, the highest quarters were Quarters 3 and 4 of 2014 when 61% and 56.5% of patients had orders for any antibiotic. In 2015, this proportion remained under 50%. Quinolones continue to have the highest median proportion of antimicrobial orders, hovering at an average of 14.3%.
CONCLUSIONS: As an interim measure, this survey has provided useful insights into the trends of antimicrobial use. We have observed an overall decrease in antimicrobial use among participating hospitals. Our data suggest that consideration should be given to taking into account the seasonality of antimicrobial use when creating benchmarks like the new Standardized Antibiotic Administration Ratio (SAAR).