title: Factors associated with the prevalence of antibiotic use for the treatment of hospital-acquired infections at 393 French hospitals: a regional variation analysis.
abstract: OBJECTIVE
  The present study investigated regional variations in antibiotic use for the treatment of hospital-acquired infections (HAIs) in France by means of a multilevel analysis, to identify targets for quality improvement.
  
  
  METHODS
  Data were obtained from the 2001 and 2006 French national point-prevalence surveys of HAIs and antibiotic use. The present study was conducted using data from 393 nonteaching public hospitals. Data included patient characteristics calculated at the hospital level (mean age and proportion of patients with the following: HAI, presence of a vascular catheter, presence of a urinary catheter, surgical procedure, and immunodeficiency) and hospital characteristics (size and presence of an intensive care unit). The regional effect was measured using a random intercept on a regional variable.
  
  
  RESULTS
  Overall, the prevalence of antibiotic use was 5.35% for both study years. The most commonly used antibiotics for HAIs were fluoroquinolones (2001, 1.33%; 2006, 1.35%) and combinations of penicillins with a β-lactamase inhibitor (2001, 0.92%; 2006, 1.02%). Mapping of antibiotic use showed wide variation between regions. The regional effect explained 3% of antibiotic variation in the unadjusted analysis. In the multivariable analysis, hospital size, high prevalence of patients with immunodeficiency, and infection characteristics explained 45% of the variability in antibiotic use. The regional effect was not retained in the final model.
  
  
  CONCLUSIONS
  The pattern of antibiotic use for HAIs differed over time, and regional variations were mostly explained by patient characteristics; there was no regional effect. Models that take data hierarchy into account are essential to better approach antibiotic use and develop relevant strategies for improvement.
authors: Institut National de la Santé et de la Recherche Médicale, Unité 657, Université de Bordeaux 2, Bordeaux, France. brice.amadeo@chu-bordeaux.fr
authors: B
authors: B
authors: Amadeo
authors: C
authors: C
authors: Dumartin
authors: A G
authors: AG
authors: Venier
authors: A
authors: A
authors: Fourrier-Réglat
authors: B
authors: B
authors: Coignard
authors: A M
authors: AM
authors: Rogues
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004363:Drug Utilization; D005602:France / Q000453:epidemiology; D005843:Geography; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence
chemical_list: D000900:Anti-Bacterial Agents