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Consideration of Seasonality in Antimicrobial Use

Posted By Raphaelle H. Beard, Jessica Vakili, Ashley Fell, and Marion A. Kainer, Friday, August 12, 2016
Updated: Wednesday, August 03, 2016

The Tennessee Dept of Health Team
The team from left to right: in the back row are Daniel Muleta, Jarred Gray, Corinne Davis, Gwen Holman, Ashley Fell. In the front row are Rebecca Meyer, Shannon Jones, Vicky Reed, and Katherine Buechel. Absent from the team photo are Michael Cavett, Patricia Lawson, Allison Chan, and Jessica Vakili (who left TDH last fall).


In 2013, the Tennessee Department of Health (TDH) developed a 21-question REDCap survey to gather data on antimicrobial use among acute care hospitals in our Antimicrobial Stewardship Collaborative. Data collection began in January 2014 and has been ongoing since. We send report packets 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 May 2016, only four hospitals in TN submit antimicrobial use (AU) data to the National Healthcare Safety Network (NHSN) AU Module. While TDH is strongly encouraging participation in the NHSN AU module, we are using this survey as an interim method to assess current prescribing habits and trends and encourage antimicrobial stewardship.


Our simple point prevalence survey captures patient census data and the number of patients with an active order for (not administration of) specific classes of antibiotics during a 24 hour period. The initial query set up usually takes about 30min. Once set up, it only takes 5-10min to run the query and no more than 10min to enter the data into the survey. Clinical pharmacists usually enter the data into REDCap and submit it to us. Ten quarters of data have been collected since survey implementation. We perform descriptive analysis quarterly, using SAS 9.4 and Excel 2010.


Each quarter, between 9 and 18 hospitals submit data. One hospital consistently submits data daily, while the majority submit quarterly. Some facilities have made big strides in antimicrobial stewardship. These efforts are reflected in their results. We have also observed a seasonal increase in AU during the winter quarters, which correlates with influenza like illness (ILI) levels in the data from the Sentinel Provider Network in TN. Third generation cephalosporins have the most pronounced seasonality.


3rd generation Cephalosporin and ILI weekly data 2014-2015


In examining trends over the first eight quarters, the highest quarters were Q3 and Q4 of 2014, when 61% and 56.5% of patients had orders for any antibiotic. In 2015, this proportion improved and remained below 50%. Quinolones continue to have the highest median proportion of antimicrobial orders, hovering at an average of 14.3%.


Any antibiotic by quarter


As an interim measure, this survey has provided useful insights into the trends of AU in Tennessee. There has been an overall decrease in AU among our participating hospitals. Our data suggest that consideration should be given to the seasonality of AU when creating benchmarks like the new Standardized Antibiotic Administration Ratio (SAAR).


Raphaelle Beard    Marion Kainer
Raphaelle Beard and Marion Kainer


Raphaelle H. Beard, MPH is epidemiologist II for Communicable and Environmental Diseases and Emergency Preparedness in the Healthcare Associated Infections Program at the Tennessee Department of Health. To take part in CSTE's ongoing efforts in antimicrobial resistance, join the Healthcare-Associated Infections Subcommittee.

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