JAC Advance Access originally published online on August 12, 2009
Journal of Antimicrobial Chemotherapy 2009 64(4):853-860; doi:10.1093/jac/dkp268
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Original research |
Antibiotic stewardship and consumption: findings from a pan-European hospital study
1 Section of Population Health, University of Aberdeen, Medical School, Aberdeen AB25 2ZD, UK 2 Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK 3 Laboratory of Healthcare Associated Infection, Centre for Infections, Health Protection Agency, London, UK 4 Centre for Statistics in Medicine, Wolfson College, Oxford OX2 6UD, UK 5 General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands 6 Department of Oncology, St. Elisabeth Cancer Institute, St. Elisabeth University College of Health Sciences, Bratislava, Slovak Republic
Received 23 April 2009; accepted 5 July 2009
* Corresponding author. Tel: +44 1224 555992; Fax: +44 1224 550925; E-mail: j.bruce{at}abdn.ac.uk
Objectives: Much has been written about antibiotic stewardship although less is known about the structure and content of antibiotic policies at hospital level. As part of the European Commission Concerted Action Antibiotic Resistance Prevention And Control (ARPAC) Project, data on antibiotic stewardship were collated and relationships investigated by antibiotic consumption in European hospitals.
Methods: A questionnaire survey on antibiotic stewardship factors was completed by 170 hospitals from 32 European countries. Data on committees, antibiotic formularies and policies addressing empirical therapy and prophylaxis were collated. Data on antibiotic use, expressed as defined daily doses per 100 occupied bed-days (DDD/100 BD), were provided by 139 hospitals from 30 countries, and 124 hospitals provided both data sets. Six key indicator stewardship variables were analysed by European region, case mix and antibiotic consumption.
Results: Hospitals from Northern and Western Europe were more likely to convene antibiotic committees or drugs and therapeutic committees compared with those from Southern and South-Eastern Europe (P < 0.001). One-fifth of hospitals had neither an antibiotic committee nor a policy. Hospital antibiotic policies commonly included recommendations on individual drugs, drug choices, dosage, duration and route but were less likely to contain information on side effects and cost. There were no significant differences by median total (J01) antibiotic consumption, although other antibiotic subgroups differed by stewardship indicators.
Conclusions: Policies and practices relating to antibiotic stewardship varied considerably across European hospitals. These data provide a benchmark for newer European strategies tackling antibiotic resistance. More work is required to achieve harmonization of recommended practice, particularly in hospitals from Southern Europe.
Keywords: antibiotic policy , antibiotic usage , hospital , survey , Europe