{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T02:52:21Z","timestamp":1783651941444,"version":"3.55.0"},"reference-count":15,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"unspecified","delay-in-days":218,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n\t  <jats:sec id=\"S2732494X25100831_as1\">\n\t    <jats:title>Objective:<\/jats:title>\n\t    <jats:p>To describe antimicrobial use in Tennessee from 2017 to 2023.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100831_as2\">\n\t    <jats:title>Design:<\/jats:title>\n\t    <jats:p>Retrospective analysis of antimicrobial use using data from the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) Option.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100831_as3\">\n\t    <jats:title>Setting:<\/jats:title>\n\t    <jats:p>Acute care and critical access facilities in Tennessee.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100831_as4\">\n\t    <jats:title>Results:<\/jats:title>\n\t    <jats:p>From 2017 to 2023, 97 facilities in Tennessee submitted data to the NHSN AU Option. The number of reporting facilities increased from 25 to 95. During this time, the statewide average antimicrobial use significantly rose from 593 days of therapy (DOT)\/1000 days present (DP) to 621 DOT\/1000 DP (<jats:italic>P<\/jats:italic> = .0478). The All-Antibacterial Standardized Antimicrobial Administration Ratio (SAAR) values remained near 1.0, indicating overall use was as predicted. However, the All-Antibacterial SAAR values, particularly in small facilities, revealed that they utilized antibiotic agents more than predicted during the study period. Additionally, the SAAR trends varied by patient care locations, with the oncology unit (ONC) experiencing a significant increase from 0.73 to 1.12 (<jats:italic>P<\/jats:italic>-value&lt;.0001). West Tennessee had the highest antimicrobial use rate at 736 DOT per 1000 DP, and an All-Antibacterial SAAR of 1.21. The top antimicrobial agents\u2014vancomycin, ceftriaxone, piperacillin\/tazobactam, cefepime, and cefazolin\u2014accounted for 54% of the total antimicrobial use.<\/jats:p>\n\t  <\/jats:sec>\n\t  <jats:sec id=\"S2732494X25100831_as5\">\n\t    <jats:title>Conclusions:<\/jats:title>\n\t    <jats:p>This statewide analysis of AU and SAAR trends identifies areas where additional antimicrobial stewardship efforts may be targeted to improve antimicrobial use. Facilities of different sizes and geographic locations have unique demographics that can affect antimicrobial use, requiring specialized antimicrobial stewardship techniques.<\/jats:p>\n\t  <\/jats:sec>","DOI":"10.1017\/ash.2025.10083","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T10:19:13Z","timestamp":1754561953000},"source":"Crossref","is-referenced-by-count":1,"title":["Statewide analysis of NHSN antimicrobial use rate and standardized antimicrobial administration ratio (SAAR) 2017\u20132023, Tennessee"],"prefix":"10.1017","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7838-0707","authenticated-orcid":false,"given":"Glodi","family":"Mutamba","sequence":"first","affiliation":[{"name":"Tennessee Department of Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0418-5540","authenticated-orcid":false,"given":"Callyn","family":"Wren","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipen","family":"Patel","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8303-7065","authenticated-orcid":false,"given":"Melphine","family":"Harriott","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9276-5067","authenticated-orcid":false,"given":"Christopher","family":"Evans","sequence":"additional","affiliation":[{"name":"Tennessee Department of Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"S2732494X25100831_ref7","unstructured":"7. Tennessee Department of Health. Reportable Diseases. https:\/\/www.tn.gov\/health\/cedep\/reportable-diseases.html. Published 2025. Accessed January 2, 2025."},{"key":"S2732494X25100831_ref3","doi-asserted-by":"crossref","unstructured":"3. O\u2019Leary, EN , Edwards, JR , Srinivasan, A , et\u00a0al. National Healthcare Safety Network standardized antimicrobial administration ratios (SAARs): a progress report and risk modeling update using 2017 data. Clin Infect Dis. 2020;71:e702\u2013e709","DOI":"10.1093\/cid\/ciaa326"},{"key":"S2732494X25100831_ref1","unstructured":"1. Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. https:\/\/www.cdc.gov\/antibiotic-use\/healthcare\/pdfs\/hospital-core-elements-H.pdf. Published 2021. Accessed September 11, 2023."},{"key":"S2732494X25100831_ref13","doi-asserted-by":"crossref","first-page":"e1544","DOI":"10.1002\/hsr2.1544","article-title":"The WHO has declared the end of pandemic phase of COVID-19: Way to come back in the normal life","volume":"6","author":"Sarker","year":"2023","journal-title":"Health Sci Rep"},{"key":"S2732494X25100831_ref4","unstructured":"4. Centers for Disease Control and Prevention. NHSN antimicrobial use and resistance module protocol. Published 2024. Available at: www.cdc.gov\/nhsn\/pdfs\/pscmanual\/11pscaurcurrent.pdf."},{"key":"S2732494X25100831_ref11","unstructured":"11. Centers for Disease Control and Prevention. Antimicrobial Use and Resistance (AUR) Module Reports. https:\/\/www.cdc.gov\/nhsn\/datastat\/aur-reports.html. Published 2023. Accessed January 13, 2025."},{"key":"S2732494X25100831_ref8","unstructured":"8. Centers for Medicare & Medicaid Services. Calendar Year 2024 Program Requirements. https:\/\/www.cms.gov\/medicare\/regulations-guidance\/promoting-interoperability-programs\/calendar-year-2024-program-requirements. Published 2024. 2025."},{"key":"S2732494X25100831_ref12","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1017\/ash.2022.266","article-title":"Show me the data: A statewide comparative report of National Healthcare Safety Network (NHSN) Antimicrobial Use Option standardized antimicrobial administration ratios (SAARs)","volume":"2","author":"Winders","year":"2022 Jul 15","journal-title":"Antimicrob Steward Healthc Epidemiol"},{"key":"S2732494X25100831_ref14","doi-asserted-by":"crossref","first-page":"106453","DOI":"10.1016\/j.ijantimicag.2021.106453","article-title":"Change in Antimicrobial Use During COVID-19 Pandemic in South Carolina Hospitals: A Multicenter Observational Cohort Study","volume":"58","author":"Winders","year":"2021","journal-title":"Int J Antimicrob Agents"},{"key":"S2732494X25100831_ref2","doi-asserted-by":"crossref","unstructured":"2. van Santen, KL , Edwards, JR , Webb, AK , et\u00a0al. The Standardized Antimicrobial Administration Ratio: A New Metric for Measuring and Comparing Antibiotic Use. Clin Infect Dis. 2018:67:179","DOI":"10.1093\/cid\/ciy075"},{"key":"S2732494X25100831_ref6","doi-asserted-by":"crossref","unstructured":"6. Magill, SS , O\u2019Leary, E , Ray, SM et\u00a0al. Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011. Clin Infect Dis. 2021;72:1784\u20131792","DOI":"10.1093\/cid\/ciaa373"},{"key":"S2732494X25100831_ref10","unstructured":"10. Centers for Disease Control and Prevention. 2023 Report: Antibiotic Use in the United States. Centers for Disease Control and Prevention website.\u00a0https:\/\/www.cdc.gov\/antibiotic-use\/media\/pdfs\/2023-stewardship-report.pdf. Published 2023. Accessed January 2, 2025."},{"key":"S2732494X25100831_ref5","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1001\/jama.2014.12923","article-title":"Prevalence of antimicrobial use in US acute care hospitals, May-September 2011","volume":"312","author":"Magill","year":"2014","journal-title":"JAMA."},{"key":"S2732494X25100831_ref9","unstructured":"9. Tennessee Department of Health. EMS Regional Offices. https:\/\/www.tn.gov\/health\/health-program-areas\/health-professional-boards\/ems-board\/ems-board\/ems-regional-offices.html. Published 2024. Accessed January 2, 2025."},{"key":"S2732494X25100831_ref15","unstructured":"15. Centers for Disease Control and Prevention. COVID-19: U.S. Impact on Antimicrobial Resistance, Special Report 2022. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2022."}],"container-title":["Antimicrobial Stewardship &amp; Healthcare Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S2732494X25100831","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T10:19:17Z","timestamp":1754561957000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S2732494X25100831\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025]]}},"alternative-id":["S2732494X25100831"],"URL":"https:\/\/doi.org\/10.1017\/ash.2025.10083","relation":{},"ISSN":["2732-494X"],"issn-type":[{"value":"2732-494X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e181"}}