OBJECTIVES: The objective of this study was to measure quantitatively antimicrobial de-escalation utilizing electronic medication administration data based on the spectrum of activity for antimicrobial therapy (i.e. spectrum score) to identify variables associated with de-escalation in a nationwide healthcare system. METHODS: A retrospective cohort study of @entity1 hospitalized for healthcare-associated @entity55 was conducted in Veterans Affairs Medical Centers (n=119). @entity1 hospitalized for healthcare-associated @entity55 on acute-care wards between 5 and 14 days who received antimicrobials for >= 3 days during calendar years 2008-11 were evaluated. The spectrum score method was applied at the @entity1 level to measure de-escalation on day 4 of hospitalization. @entity1052 was expressed in aggregate and facility-level proportions. Logistic regression was used to assess variables associated with de-escalation. ORs with 95% CIs were reported. RESULTS: Among 9319 @entity1 , the de-escalation proportion was 28.3% (95% CI 27.4-29.2), which varied 6-fold across facilities [median (IQR) facility-level de-escalation proportion 29.1% (95% CI 21.7-35.6)]. Variables associated with de-escalation included initial broad-spectrum therapy (OR 1.5, 95% CI 1.4-1.5 for each 10% increase in spectrum), collection of respiratory tract cultures ( @entity24773 , 95% CI 1.0-1.2) and care in higher complexity facilities ( @entity24353 , 95% CI 1.1-1.6). Respiratory tract cultures were collected from 35.3% (95% CI 32.7-37.7) of @entity1 . CONCLUSIONS: @entity1052 of antimicrobial therapy was limited and varied substantially across facilities. @entity1052 was associated with respiratory tract culture collection and treatment in a high complexity-level facility.

Antimicrobial de-escalation of treatment for healthcare-associated XXXX within the Veterans Healthcare Administration.

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient'] @entity1052 :: ('MESH:D005862', 'Disease') :: ['De-escalation'] @entity24353 :: ('128360', 'Gene') :: ['OR 1.3'] @entity55 :: ('MESH:D011014', 'Disease') :: ['pneumonia'] @entity24773 :: ('81399', 'Gene') :: ['OR 1.1']
@entity55 :: (MESH:D011014,Disease) :: ['pneumonia']
