Correlates of antibiotic use in Taiwan hospitals

OBJECTIVE: To determine factors that correlate with increased antibiotic us e among adult inpatients in Taiwan. DESIGN: Retrospective survey of medical records. SETTING: 14 acute-care hospitals (8 regional hospitals, 6 medical centers) in Taiwan. PARTICIPANTS: A systematic probability sample from each hospital, totaling 663 adult inpatients who were discharged or had died in early 1999. MEASUREMENTS: Infectious disease physicians at the 14 hospitals collected d ata from medical records regarding patient demographics, hospitalization, d ischarge diagnosis, and antibiotics received. RESULTS: A total of 447 (67%) patients received antibiotics for an overall rate of 813 antibiotic-days (number of days patients received each antibiot ic)/1,000 patient-days. Both the proportion of beds in intensive care units ([ICUs] Pearson correlation coefficient [r], 0.67; 95% confidence interval [CI95], 0.36-0.89; P < .01) and the proportion of patients admitted to sur gical services (r, 0.66; CI95, 0.20-0.88; P=.01) correlated with the mean p atient rate of antibiotic-days/hospital-day (MPAUD). In contrast, we found no correlation between the proportion of patients who received antibiotics and the MPAUD. Using multiple linear regression, medical center status wash the only independent predictor for increased MPAUD, (regression coefficien t [b], 0.15; CI95, 0.05-0.24; P < .01). There was no correlation between po oled rates of antibiotic-days/hospital-day and any hospital demographic fac tors. First-generation cephalosporin (39%) and aminoglycoside (24%) use acc ounted for the majority of antibiotic-days. CONCLUSIONS: Antibiotic use is greater in medical centers than in regional hospitals and appears to be independent of surgical case mix or the proport ion of ICU beds. Determination of multiple, independent measures of antibio tic use may be necessary to understand the relation between antibiotic use and resistance in hospitals (Infect Control Hosp Epidemiol 2001;22:565-571) .