title: Antibiotic use in 26 departments of internal medicine in 6 general hospitals in Israel: variability and contributing factors.
abstract: OBJECTIVE
  Increased antibiotic consumption is associated with increased bacterial resistance worldwide. We aimed to analyse antibiotic consumption and potential contributory factors in internal medicine departments in Israel.
  
  
  METHODS
  Data (2003-04) from 26 departments in 6 hospitals were retrieved. Defined daily doses (DDD)/100 bed-days were calculated for total antibiotic use and by antibiotic class. Patterns identified were correlated with 15 patients' and departmental variables by univariate and multivariate analyses.
  
  
  RESULTS
  Total antibiotic consumption differed by a factor of 2.3 (115 DDD/100 bed-days to 49.1 DDD/100 bed-days) between the highest and lowest consuming departments. Antibiotic classes differed by a factor of 22.8 for macrolides, a factor of 20 for piperacillin/tazobactam, a factor of 17 for carbapenems, a factor of 13.3 for quinolones, a factor of 9 for vancomycin, a factor of 6.8 for amoxicillin/clavulanate, a factor of 6.6 for aminoglycosides, a factor of 5.3 for penicillins and a factor of 2.8 for cephalosporins. Even among departments within hospitals, there was a difference of up to 1.5-fold for total use and antibiotic class differences ranged between 2.5- and 7.2-fold for third- and fourth-generation cephalosporins, despite similar Charlson scores and other patient variables. In the multivariate analysis, hospital affiliation and rate of 1 day hospitalization were the only significant variables predicting total antibiotic use, contributing 43% and 7.3%, respectively, to the variance. By antibiotic class, controlling for hospital affiliation, patients with neutropenia, lower respiratory tract infections and assisted ventilation were the most common significant contributors, ranging from 3.5% for quinolones to 7.7% for piperacillin/tazobactam.
  
  
  CONCLUSIONS
  Patterns of antibiotic use vary widely among internal medicine departments in Israel, which cannot be explained by objective parameters related either to patients or wards. Ongoing monitoring and guideline formulation are needed to regulate antibiotic prescription.
authors.affiliation: 'Clalit' Health Services, Hospital Division, Tel Aviv, Israel. itamar_s@clalit.org.il
authors.forename: Itamar
authors.initials: I
authors.lastname: Shalit
authors.forename: Marcelo
authors.initials: M
authors.lastname: Low
authors.forename: Erez
authors.initials: E
authors.lastname: Levy
authors.forename: Michal
authors.initials: M
authors.lastname: Chowers
authors.forename: Oren
authors.initials: O
authors.lastname: Zimhony
authors.forename: Klaris
authors.initials: K
authors.lastname: Riesenberg
authors.forename: Jihad
authors.initials: J
authors.lastname: Bishara
authors.forename: Raul
authors.initials: R
authors.lastname: Raz
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D004363:Drug Utilization; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents