Hospital antibiotic prescribing in hospitals from 18 European countries 20002005: longitudinal analysis with comparison of adjustment for changes in clinical activity using admissions or occupied bed days
Abstract number: O398
Ansari F., Goossens H., Ferech M., Muller A., Molana H., Davey P.G.
Objective: To collect data about hospital antibiotic use with standardised methods in different European countries. The data were used to answer two research questions:
1What is the trend in hospital antibiotic use over time?
2What effect does adjustment for bed days or admissions have on trends in hospital antibiotic use?
Methods: A total of 18 hospitals participated in the study, one hospital from each of 18 countries. We collected monthly data about total antibiotic use over 6 years starting from January 2000. Crude data about antibiotic use was converted to the ATC drug classification and Defined Daily Doses (DDD).
Results: Antibiotic use measured in DDD increased in 14 hospitals and decreased in 4 hospitals. There was an underlying trend of reducing length of stay in 16 of the 18 hospitals. Consequently annual changes in DDD per 100 occupied bed days (DBD) were also greater than annual changes in DDD per 100 admissions (DAD) in 16 of the 18 hospitals. Overall there were five distinct patterns of antibiotic use over time:
1Increasing antibiotic use that was not fully explained by increased clinical activity (11 hospitals). Increases in DDD over time remained after adjustment with either bed days or admissions.
2Increasing antibiotic use was entirely explained by increased clinical activity (1 hospital). The increase in DDD over time reversed to a decrease in DBD and DAD. Hence the apparent increase in antibiotic use was entirely due to a large increase in clinical activity.
3Divergence between DBD and DAD (2 hospitals). The increase in DDD was reversed when adjusted for admissions but persisted when adjusted for bed days. The divergent results were a consequence of an increasing number of admissions combined with reducing length of stay. The apparent increase in antibiotic use was likely to be explained by increase in clinical activity.
4Decreasing antibiotic use that was not fully explained by decreased clinical activity (3 hospitals).
5Decreasing antibiotic use that was entirely explained by decreased clinical activity (1 hospital).
Conclusions: Interpretation of longitudinal surveillance data about antibiotic use is facilitated by presentation of changes in DDD without adjustment for clinical activity in addition to adjusted data. Antibiotic use is influenced by number of admissions and by length of stay; consequently adjustment for clinical activity should be done with both admissions and occupied bed days.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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