[Diversity in antibiotic use in intensive care units in Germany].
BACKGROUND
The aim of the study was to present data from the SARI study (Surveillance of Antibiotic Use and Bacterial Resistance in Intensive Care Units) on antibiotic use in Intensive care Units (ICU) in Germany and to determine parameters responsible for involved in the diversity of antibiotic usage.


METHODS
Antibiotic administration in 43 intensive care units in Germany was recorded. Antibiotic usage density (AD) was measured: it describes the use of antibiotics and is expressed as defined daily doses (DDD) and is normalized per 1000 patient-days (pd). Prescribing parameters were the number of antibiotics administered, the amount of the most frequently used antibiotics as a percentage of total antibiotic use and the percentage of selected antibiotic groups as part of total use.


RESULTS
Median antibiotic use was 1156 DDDs per 1000 patient-days in the year 2005. However, antibiotic administration was very heterogeneous and ranged from 450 to 1 799 DDDs/1 000 pd. There was no statistically significant association between total use and status or type of hospital and type of ICU. Use of antibiotic groups was also heterogeneous: if pooled data are taken, penicillins and cephalosporins each accounting for a quarter of total antibiotic use. In individual ICUs the use of quinolones was more than 35% of all drugs given, 3rd and 4th generation cephalosporins almost 40% and carbapenems up to 30%. The most frequently used antibiotic per ICU made up 17% (median) of total antibiotic use, the three most frequently administered antibiotics accounting for up to 40%.


CONCLUSIONS
The great heterogeneity of antibiotic use may indicate room for improvement. Prescribing parameters such as the percentage of antibiotic groups among total antibiotic usage provide additional information on the selective pressure of antibiotics used in the ICU beyond quantitative data on drug administration.
Meyer
E
E
Institut für Umweltmedizin und Krankenhaushygiene, Universitätsklinikum Freiburg, Breisacher Str. 115B, 79106 Freiburg. elisabeth.meyer@uniklinik-freiburg.de
Schwab
F
F
Schroeren-Boersch
B
B
Rüden
H
H
Gastmeier
P
P
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004351:Drug Resistance / Q000187:drug effects; D017723:Drug Utilization Review; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D007902:Length of Stay; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D018571:Sentinel Surveillance
D000900:Anti-Bacterial Agents