Antimicrobial Use in U.S. Hospitals: Comparison of 2015 and 2023 Prevalence Surveys
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Prevalence surveys in U.S. hospitals in 2011 and 2015 showed that half of inpatients received antimicrobials on the survey day or day before. We repeated the survey in 2023 to assess changes in antimicrobial use (AU). Methods: Ten Emerging Infections Program (EIP) sites recruited up to 25 hospitals each, prioritizing prior participants. EIP staff reviewed medical records of randomly selected inpatients from the survey day morning census and documented AU on the survey day or day before. We compared AU and stewardship characteristics between 2023 and 2015 and used multivariable log-binomial regression to identify factors associated with AU in 2023. Results: Antimicrobial stewardship programs were present in 215/218 hospitals in 2023 (98.6%) compared with 158/199 (79.4%) in 2015. Of 13 653 patients in 2023, 6785 (49.7%) received ≥1 antimicrobial on the survey day or day before. Among 151 hospitals participating in both surveys, overall AU prevalence was similar in 2015 and 2023 (49.2% vs 49.1%), with decreases in neonatal critical care (23.4% to 17.1%) and increases in mother-baby units (24.4% to 32.8%). Fluoroquinolone use declined (9.2% to 2.8%), while third- or fourth-generation cephalosporin use increased (12.3% to 18.6%). In 2023, higher AU was associated with patient factors (medical devices, inpatient location, obesity, 4-17 day hospital stays, and suburban residence) and hospital factors (Northeast and South regions, AU audits). Conclusions: One in two inpatients received an antimicrobial in 2023, similar to 2015. However, changes in AU by inpatient location and antimicrobial class suggest evolving prescribing practices and may inform targeted surveillance and stewardship efforts.
Source: Open Forum Infectious Diseases
DOI: 10.1093/ofid/ofag450
Authors: Barbara C Keino, Taniece Eure, Rebecca Alkis Ramirez, Joelle Nadle, Jane E Lee, Monica Lehmann, Lyndzie Sardenga, Christopher A Czaja, Helen Johnston, Melissa Kellogg, Catherine Emanuel, Alana Cilwick, Maria A Correa, Meghan Maloney, Jeanette Prignano, Susan M Ray, Jessica Howard-Anderson, Stacy Carswell, Lucy E Wilson, Rebecca Perlmutter, J P Mahoehney, Ruth Lynfield, Marla Sievers, Cory Cline, Melissa Judson, Ghinwa Dumyati, Christine Hurley, Elizabeth Keller, Marissa Walsh, Erin Licherdell, Julia Tellerman, Rebecca Pierce, Valerie L S Ocampo, Monika E Samper, Kimberly A Hires, Lauren T Adrian, Roza P Tammer, Alexia Y Zhang, Shannon Hiratzka, Angela Dusko, Christopher Wilson, Melphine Harriott, Rongxia Li, Melinda M Neuhauser, Nicola D Thompson, Shelley S Magill, Cheri T Grigg, Nora Chea
Institutions: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Colorado Department of Public Health and Environment, Yale University, Connecticut Department of Public Health, Emory University, Maryland Department of Health, Minnesota Department of Health, New Mexico Department of Health, University of Rochester Medicine, Oregon Health Authority, Tennessee Department of Health
Language: English
Subfield: Applied Microbiology and Biotechnology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $4,053
Funders: Minnesota Department of Health, Colorado Department of Public Health and Environment, University of Rochester, Healthcare Quality Foundation, Centers for Disease Control and Prevention Foundation, National Institutes of Health, Centers for Disease Control and Prevention, Medical Center, University of Rochester, National Center for Emerging and Zoonotic Infectious Diseases
Awards: G1308113280, G2133739534, G2942211325
OpenAlex ID: W7171965328