Does a reduction in antibiotic consumption always represent a favorable outcome from an intervention program on prescribing practice?
OBJECTIVE
In our hospital, a continuous intervention program aimed at optimizing the quality of antibiotic use was introduced by late 1999 and antibiotic consumption was a major outcome for assessment. However, healthcare conditions have been subject to change over the last five years, and a pronounced economic crisis in 2002 affected the availability of antibiotics. Therefore, we hypothesized that the consumption of these drugs could be a suitable indirect marker of the crisis.


METHODS
We performed segmented regression analysis between different periods. Variations in antibiotic consumption during periods corresponding to the four-phase intervention program (from 1999 to the first six months of 2001) were assumed to be 'intervention-induced', while those observed during the crisis period were considered as 'situation-enforced'.


RESULTS
Whereas the intervention-induced (desirable) decrease of total antibiotic and carbapenem consumption proved to correlate with a decreased crude mortality rate during the control period prior to the crisis (R2, 0.82 and 0.91, respectively), the crisis-induced (undesirable) decrease in total antibiotic and carbapenem consumption correlated with an increased mortality during this phase (R2, 0.80 and 0.75, respectively).


CONCLUSIONS
Our results illustrate that a reduction in antibiotic consumption does not always represent a favorable outcome from an intervention program on prescribing practice. Moreover, it may be a sensitive indirect marker of a deficient healthcare condition leading to an increase in in-hospital mortality.
Bantar
Carlos
C
Services of Infection Control, Hospital San Martín, Paraná, Entre Ríos, Argentina. cbantar@arnet.com.ar
Franco
Diego
D
Heft
Claudia
C
Vesco
Eduardo
E
Arango
Carina
C
Izaguirre
Mariano
M
Oliva
María Eugenia
ME
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D018709:Statistics, Nonparametric
D000900:Anti-Bacterial Agents