JAC Advance Access published online on June 30, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn260
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Original research |
Antibiotic consumption in southern and eastern Mediterranean hospitals: results from the ARMed project
1 Infection Control Unit, Mater Dei Hospital, Msida, Malta 2 Department of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk-Antwerp, Belgium
Received 22 January 2008; returned 16 April 2008; revised 20 May 2008; accepted 1 June 2008
* Corresponding author. Tel: +356-2545-4528; Fax: +356-2545-4541; E-mail: michael.a.borg{at}gov.mt
Objectives: The intensity of antibiotic use in hospital settings is recognized as possibly the most important factor for the selection of antimicrobial resistance. Hospitals are therefore being encouraged to undertake surveillance and benchmarking of antimicrobial consumption patterns with a view to identify and rectify possible evidence of overuse or misuse.
Methods: As part of the ARMed project, antibiotic use in 25 hospitals from the southern and eastern Mediterranean countries of Cyprus, Egypt, Jordan, Lebanon, Malta, Tunisia and Turkey was assessed prospectively for 24 months during the years 2004–05. The surveillance focused primarily on systemic antibiotics used in hospital care, aggregated at the level of the active substance, in accordance with the Anatomic Therapeutic Chemical (ATC) classification.
Results: The median total antibiotic use during the study period was 112 defined daily doses per 100 bed-days (DDD/100BD), with an inter-quartile range of 84–428 DDD/100BD. The most common antibiotic groups prescribed were the extended-spectrum and combination penicillins, first- and third-generation cephalosporins and quinolones. Overall, a predominant consumption of wide-spectrum agents was noted, with a significant correlation between the levels of use of third-generation cephalosporins and carbapenems.
Conclusions: Emphasis on wide-spectrum agents could explain one possible factor behind the documented high prevalence of resistance in important pathogens within these same hospitals and suggests the need for improved antibiotic stewardship and prescribing programmes, which may well be applicable to the whole region.
Key Words: surveillance , resistance , ATC , DDD , carbapenems , cephalosporins , penicillins