Diversity of antimicrobial use and resistance in 42 hospitals in the United States

Pharmacotherapy. 2008 Jul;28(7):906-12. doi: 10.1592/phco.28.7.906.


Study objective: To measure diversity (or heterogeneity) of antibiotic use in a sample of hospitals in the United States and to assess an association with bacterial resistance.

Design: Observational cross-sectional study.

Setting: Forty-two general medical-surgical hospitals, mostly in the Eastern United States.

Data source: Administrative claims data and hospital antibiograms during 2003.

Measurements and main results: Antibiotic use was measured by defined daily dose (DDD), and diversity was assessed by using Simpson's Index and the Shannon-Weiner Index. Aggregated antibiograms (from 17 hospitals) were used to assess resistance. There were a total of 3,655,579 patient-days during 2003, with a mean +/- SD of 87,037 +/- 62,679 patient-days/hospital. Mean +/- SD antibiotic use was 704 +/- 244 DDD/1000 patient-days/hospital, and fluoroquinolones represented the largest single class. Mean +/- SD diversity by Simpson's Index was 0.861 +/- 0.022/hospital, and a strong correlation was noted between the two diversity measures. Multivariate analysis found no significant relationship between diversity and the proportion of resistant pathogens.

Conclusion: Diversity of aggregate antibiotic use can be measured, but additional investigations are needed to determine if it is a useful strategy to contain resistance.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use*
  • Cephalosporins
  • Cross-Sectional Studies
  • Drug Resistance, Bacterial*
  • Drug Utilization Review*
  • Fluoroquinolones / administration & dosage
  • Fluoroquinolones / therapeutic use
  • Humans
  • Imipenem / administration & dosage
  • Imipenem / therapeutic use
  • Methicillin / administration & dosage
  • Methicillin / therapeutic use
  • Multivariate Analysis
  • United States


  • Anti-Bacterial Agents
  • Cephalosporins
  • Fluoroquinolones
  • Imipenem
  • Methicillin