Objective:

To determine the evolution of the institutional policies to control use of antibiotics and to improve antimicrobial use.

Participants and method:

Pharmacy and infection control staff at 37 hospitals participating in the survey conducted by the CCLIN SO. We collected information about total antibiotics used and about susceptibility of Staphylococcus aureus and Pseudomonas aeruginosa isolates recovered from clinical specimen during 12 consecutive months, as well as descriptions of the type of antibiotic management policies and procedures being used by the individual hospitals by means of a standardised questionnaire in 1999 and in 2002. Responses were analysed using chi-square MacNemar and Wilcoxon matched-pairs signed-ranks test.

Results:

37 hospitals with a median of 205 beds (range 28–893) and with a mean of 54 029 patients-days in 2002. Respectively, in 1999 and in 2002: a local committee supervised antibiotics use in 47 and 80% of the hospitals (P < 0.01), 80% had a validation process before dispensing antibiotics. Local clinical practice guidelines were reported at 29.7 and 48.6% of the hospitals, feed-back information existing in 51 and 83.7% (P < 0.01) for antibiotic consumption and in 57 and 86.5% for antibiotic resistance (P < 0.01). Fewer than 30% used computer for the management of dispensing of antibiotics. Only 3% used an electronic network to share information on antibiotics prescription and bacteriological results. Fewer than 30% reported evaluation of antibiotic practices. Decreasing in antibiotics consumption was not significant: respectively, 364 and 345 defined daily doses per 1000 patients-days (DDD/1000). In 2002, a lower antibiotic consumption was associated significantly with antibiotic order form obligatory for getting the drug from pharmacy (441 vs. 305 DDD/1000). Variations of bacterial resistance rates were not significant for Staphylococcus aureus and methicillin, Pseudomonas aeruginosa and imipenem or ceftazidime or ciprofloxacin.

Conclusion:

Our survey shows improvement in the reported antimicrobial use programmes but hospitals also must focused on appropriateness of use and on computer equipment.