Levels of prescribing for four major antibiotic classes and rates of septicemia hospitalization in different US states

Background: Rates of sepsis/septicemia hospitalization in the US have risen significantly during recent years, and antibiotic resistance and use may contribute to those rates through various mechanisms. Methods: We used multivariate Poisson regression to relate state-specific rates of outpatient prescribing overall for four antibiotic classes: fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011-2012 to state-specific counts of hospitalizations with septicemia (ICD-9 codes 038.xx present anywhere on discharge diagnosis) in each of the following age groups of adults: (18-49y, 50-64y, 65-74y, 75-84y, 85+y) reported to the Healthcare Cost and Utilization Project (HCUP) between 2011-2012, adjusting for median household income and population density.Results: The regression coefficients were positive for the rates of prescribing of fluoroquinolones, penicillins, as well as cephalosporins in the analysis for adults aged 18-49y, and negative for macrolides, and cephalosporins in the analyses for adults aged 50+y. Conclusions: Antibiotic stewardship, particularly for fluoroquinolones, as well as penicillins could be beneficial for reducing the rates of sepsis hospitalization. Negative estimates in the regression analyses suggest that the relative share of the use of different antibiotics in the treatment of various syndromes may affect the rates of sepsis hospitalization. Further studies of those issues are needed to inform antibiotic prescribing guidelines.