Specific control measures for antibiotic prescription are related to lower consumption in hospitals: results from a French multicentre pilot study.
BACKGROUND
In France, antibiotic consumption (ABC) is dramatically high in parallel with the high rate of multidrug-resistant bacteria. For the last few years, a nationwide policy has been implemented at the national level to control and monitor ABC. Since 2002, surveillance networks have been set up with voluntary hospitals to evaluate the antibiotic policy and consumption. The present study was conducted to identify whether specific control measures of the antibiotic policy could reduce ABC in hospitals.


METHODS
Based on the data from the Northern France surveillance system, local recommendations and antibiotic use were collected annually on a standardized questionnaire that had 21 items. ABC was expressed in defined daily doses (DDDs) per 1000 patient-days (PDs). The ABC indicator was the overall antibiotic consumption. A multivariate logistic regression analysis was performed using low (< or =75th percentile) and high (>75th percentile) ABC as the dependent variable.


RESULTS
A total of 83/111 hospitals were included in the study. In 75% of the hospitals, total ABC was < or =669.5 DDDs/1000 PDs. The less frequent practices were educational antibiotic programmes (17%), authorization from an antibiotic specialist for selected antibiotics (26%) and systematic reassessment of AB treatment after 72 h (27%). In the multivariate analysis, three variables remained significantly and independently associated (P < 0.05) with ABC: the type of hospital, the proportion of non-acute-care beds and the nominative delivery form as the only antibiotic control measure. Total ABC was lower in hospitals having a nominative delivery form, compared with hospitals not having it. Conversely, ABC was significantly higher in public teaching hospitals compared with non-teaching hospitals. Similarly, ABC was higher in hospitals with a lowest proportion (i.e. < or =25%) of non-acute-care beds compared with hospitals where this proportion was >25%.


CONCLUSIONS
Specific control measures could lower ABC. Sustained control efforts should focus on antibiotics with the highest potential for emerging bacterial resistance.
Miliani
Katiuska
K
Regional Co-ordinating Centre for Nosocomial Infection Control (C-CLIN Paris-Nord), Paris, France.
L'Hériteau
François
F
Alfandari
Serge
S
Arnaud
Isabelle
I
Costa
Yannick
Y
Delière
Elisabeth
E
Carbonne
Anne
A
Astagneau
Pascal
P
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D005602:France; D019983:Guideline Adherence; D006291:Health Policy; D006761:Hospitals; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D010865:Pilot Projects; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents