2891. Trends in Inpatient Antibiotic Use in US Hospitals, 2012–2017

BACKGROUND: The National Action Plan for Combating Antibiotic-resistant Bacteria calls for monitoring inpatient antibiotic use to inform stewardship efforts. We estimated national trends in inpatient antibiotic usage from 2012 to 2017 in a large cohort of US hospitals. METHODS: We utilized the Premier Healthcare Database, containing detailed administrative records available by census region, including inpatient drug utilization data based on billing records, for all patients discharged from a convenience sample of over 700 US hospitals annually, approximately 20% of US inpatient discharges. We retrospectively estimated days of therapy (DOT)/1,000 patient-days (PDs) by year overall and by antibiotic class. To examine trends over time, we created multivariable models adjusting for hospital-specific location of antibiotic use (ICU vs. other) and hospital-specific summary measures including average patient age, average co-morbidity score, case mix index, number of hospital beds, teaching status, urban/rural location, US census division, proportion of discharges with a surgical diagnosis-related code, and proportion of PDs with an infectious disease primary ICD-9/10-CM discharge code. Estimates and models were weighted to be nationally representative using projected weights from the database. RESULTS: 58% of patients had at least one antibiotic DOT, and the overall DOT for all hospitals was 810 DOT/1,000 PDs (interquartile range 701 to 913 DOT/1,000 PDs). Glycopeptides and third-/fourth-generation cephalosporins were the most common antibiotic classes (Figure 1). Overall antibiotic DOT did not change significantly over time, P = 0.9133. However, class-specific DOT varied with large decreases in fluoroquinolones from 2012 to 2017 (55% decrease, P < 0.0001), and large increases in third-/fourth-generation cephalosporins and tetracyclines (32% and 49% increase, respectively, P < 0.0001) (Figure 2). Overall antibiotic DOT significantly varied among US census divisions (Figure 3). CONCLUSION: Estimated overall inpatient antibiotic DOT did not change in US hospitals from 2012 to 2017, but there were significant class-specific changes. The large decrease in fluoroquinolone use may reflect increased awareness of adverse events. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All Authors: No reported Disclosures.