Antibiotic use and cost indicators at a rural hospital: A pilot project

Background: Recently, simple antibiotic use and cost indicators were developed for use in longterm care facilities. It was hypothesized that these indicators also may be applicable to the acute hospital setting. Methods: For a 24-month period, data were collected quarterly on antibiotic use and cost indicators for 11 primary care physicians in a 40-bed rural hospital. Indicators included antimicrobial use ratio (AUR, ratio of the number of antibiotic days to the number of patient care days), cost per antibiotic day, and cost of antibiotics per patient care day. One-way analysis of variance and simple linear regression were used to analyze data. Results: Quinolones (oral plus parenteral) accounted for 26% of the total antibiotic days (N = 6020) followed by ceftriaxone (19%) and cefuroxime (11,8%; oral plus parenteral). Overall trends in antibiotic use and cost included a significant increase in quarterly AUR (R² = 0.78, P = .004) and cost per patient care day (R² = 0.82, P = .002) but no significant change in quarterly total antibiotic costs or cost per antibiotic day. Among physicians there was a significant difference in mean quarterly AUR (P < .001) and mean quarterly cost per patient care day (P < .001) but no significant difference in mean quarterly cost per antibiotic day. Variation in physician-specific cost per patient care day was best explained by variation in AUR (R² = 0.75, P < .001). Conclusions: Significant variation in simple antibiotic use and cost indicators was identified at a rural hospital from both the facility and physician perspective. Standardized methods for antibiotic use and cost monitoring, like the one described in this article, are required before the relationship between antibiotic use and resistance can be fully understood.