Antibiotic consumption in southern and eastern Mediterranean hospitals: results from the ARMed project.
OBJECTIVE
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.
Borg
Michael A
MA
Infection Control Unit, Mater Dei Hospital, Msida, Malta. michael.a.borg@gov.mt
Zarb
Peter
P
Ferech
Matus
M
Goossens
Herman
H
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D019083:Mediterranean Region; D011446:Prospective Studies
D000900:Anti-Bacterial Agents