Development of standardized methods for analysis of changes in antibacterial use in hospitals from 18 European countries: the European Surveillance of Antimicrobial Consumption (ESAC) longitudinal survey, 2000–06

Ansari, Faranak; Molana, Hassan; Goossens, Herman; Davey, Peter; Ferech, Matus; Metz, Sigrid; Jansens, Hilde; Andrašević, Arjana Tambić; Cazin, I; Mach, Rene; Vlček, Jiřı́; Molstad, Birgit; Jamieson, Conor; Mitt, Piret; Elomaa, Nina; Patry, Isabelle; Bertrand, Xavier; Antoniadou, Anastasia; Giamarellou, Helen; Pujate, E.; Filius, Margreet; Pennerden, Claire van Nispen tot; Syrrist, Cecile; Hill, Kirsteen; Čižman, Milan; Erntell, Mats; Gür, Deniz; Heginbothom, Maggie

doi:10.1093/jac/dkq378

Cited by 26 publications

(25 citation statements)

References 11 publications

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“…The results of our surveillance call attention to the extensive prescription of broad-spectrum antibiotics in Singaporean hospitals. This is much higher compared to results from European hospitals [9]–[11], but is similar to those from a neighboring Asian hospital [12]. Part of this may be attributable to the high rates of antimicrobial resistance in the region [6], [7], [12], [13] that in turn drive up prescription of Gram-positive agents, carbapenems and polymyxins respectively.…”

Section: Discussionmentioning

confidence: 56%

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Surveillance of Broad-Spectrum Antibiotic Prescription in Singaporean Hospitals: A 5-Year Longitudinal Study

et al. 2011

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BackgroundInappropriate prescription of antibiotics may contribute towards higher levels antimicrobial resistance. A key intervention for improving appropriate antibiotic prescription is surveillance of prescription. This paper presents the results of a longitudinal surveillance of broad-spectrum antibiotic prescription in 5 public-sector hospitals in Singapore from 2006 to 2010.Methodology/Principal FindingsQuarterly antibiotic prescription data were obtained and converted to defined daily doses (DDDs) per 1,000 inpatient-days. The presence of significant trends in antibiotic prescription over time for both individual and combined hospitals was tested by regression analysis and corrected for autocorrelation between time-points. Excluding fluoroquinolones, there was a significant increase in prescription of all monitored antibiotics from an average of 233.12 defined daily doses (DDD)/1,000 inpatient-days in 2006 to 254.38 DDD/1,000 inpatient-days in 2010 (Coefficient = 1.13, 95%CI: 0.16–2.09, p = 0.025). Increasing utilization of carbapenems, piperacillin/tazobactam, and Gram-positive agents were seen in the majority of the hospitals, while cephalosporins were less prescribed over time. The combined expenditure for 5 hospitals increased from USD9.9 million in 2006 to USD16.7 million in 2010.Conclusions/SignificanceThe rate of prescription of broad-spectrum antibiotics in Singaporean hospitals is much higher compared to those of European hospitals. This may be due to high rates of antimicrobial resistance. The increase in expenditure on monitored antibiotics over the past 5 years outstripped the actual increase in DDD/1,000 inpatient-days of antibiotics prescribed. Longitudinal surveillance of antibiotic prescription on a hospital and countrywide level is important for detecting trends for formulating interventions or policies. Further research is needed to understand the causes for the various prescription trends and to act on these where necessary.

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Section: Discussionmentioning

confidence: 56%

“…This work adds to the available sparse literature on country-level reports of hospital antibiotic consumption [9]–[11]. The surveillance program provides participating hospitals useful data for monitoring broad-spectrum antibiotic prescription and allows for benchmarking at the individual hospital level.…”

Section: Discussionmentioning

confidence: 99%

Surveillance of Broad-Spectrum Antibiotic Prescription in Singaporean Hospitals: A 5-Year Longitudinal Study

et al. 2011

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“…In the recently published Cochrane metaanalysis [18] most of the 86 finally included studies with adequate quality were designed as ITS analysis, underscoring the importance of this type of evaluation in field of ABS [18,21]. In fact, we considered it as essential to measure and evaluate time trends for antibiotic use, both in and outside the primary target service by ITS analysis to estimate the contribution of our additional efforts optimizing antimicrobial drug treatment.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and impact of an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a tertiary care university medical center

et al. 2014

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BackgroundRestricted use of third-generation cephalosporins and fluoroquinolones has been linked to a reduced incidence of hospital-acquired infections with multidrug-resistant bacteria. We implemented an intensified antibiotic stewardship (ABS) programme in the medical service of a university hospital center aiming at a reduction by at least 30% in the use of these two drug classes.MethodsThe ABS programme was focused on the 300-bed medical service. Prescription of third-generation cephalosporins was discouraged, whereas the use of penicillins was encouraged. Monthly drug use density was measured in WHO-ATC defined and locally recommended daily doses (DDD and RDD) per 100 patient days, to evaluate trends before (01/2008 to 10/2011) and after starting the intervention (1/2012 to 3/2013). The effect was analysed using interrupted time-series analysis with six non-intervention departments as controls.ResultsFollowing initiation of the ABS intervention, overall antibiotic use in the medical service declined (p < 0.001). There was a significant intervention-related decrease in the use of cephalosporins and fluoroquinolones (p < 0.001) outperforming the decreasing baseline trend. Trend changes observed in some of the control departments were smaller, and the difference between trend changes in the medical service and those in control departments were highly significant for overall use and cephalosporin use reductions (p < 0.001) as well as for the increasing use of penicillins (p < 0.001). Mean use density levels (in RDD per 100 patient days) dropped for cephalosporins from 16.3 to 10.3 (−37%) and for fluoroquinolones from 17.7 to 10.1 (−43%), respectively. During the same period, the use of penicillins increased (15.4 to 18.2; 18%). The changes in expenditures for antibiotics in the medical service compared to control services minus programme costs indicated initial net cost savings likely to be associated with the programme.ConclusionAn intensified ABS programme targeting cephalosporin und fluoroquinolone use in the setting of a large academic hospital is feasible and effective. The intervention may serve as a model for other services and hospitals with a similar structure and baseline situation.

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“…Large antimicrobial utilization surveillance projects have generally used DDD-based measures. 19,20 The availability of eMAR data from patient care management systems in acute care greatly enhances the accessibility of data for the purposes of antimicrobial stewardship and is relatively easy to convert to DOT data. DOT have been regarded as the preferable metric, 5,6,8 since the deviation of dosages used clinically from the WHO-set DDD value does not impact this measure.…”

Section: Resultsmentioning

confidence: 99%

Assessment of Antimicrobial Utilization Metrics: Days of Therapy Versus Defined Daily Doses and Pharmacy Dispensing Records Versus Nursing Administration Data

Dalton

Sabuda

Bresee

et al. 2015

Infect. Control Hosp. Epidemiol.

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Development of standardized methods for analysis of changes in antibacterial use in hospitals from 18 European countries: the European Surveillance of Antimicrobial Consumption (ESAC) longitudinal survey, 2000–06

Cited by 26 publications

References 11 publications

Surveillance of Broad-Spectrum Antibiotic Prescription in Singaporean Hospitals: A 5-Year Longitudinal Study

Surveillance of Broad-Spectrum Antibiotic Prescription in Singaporean Hospitals: A 5-Year Longitudinal Study

Feasibility and impact of an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a tertiary care university medical center

Assessment of Antimicrobial Utilization Metrics: Days of Therapy Versus Defined Daily Doses and Pharmacy Dispensing Records Versus Nursing Administration Data

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