title: Surveillance of broad-spectrum antibiotic prescription in Singaporean hospitals: a 5-year longitudinal study.
abstract: BACKGROUND
  Inappropriate prescription of antibiotics may contribute towards higher levels antimicrobial resistance. A key intervention for improving appropriate antibiotic prescription is surveillance of prescription. This paper presents the results of a longitudinal surveillance of broad-spectrum antibiotic prescription in 5 public-sector hospitals in Singapore from 2006 to 2010.
  
  
  RESULTS
  Quarterly antibiotic prescription data were obtained and converted to defined daily doses (DDDs) per 1,000 inpatient-days. The presence of significant trends in antibiotic prescription over time for both individual and combined hospitals was tested by regression analysis and corrected for autocorrelation between time-points. Excluding fluoroquinolones, there was a significant increase in prescription of all monitored antibiotics from an average of 233.12 defined daily doses (DDD)/1,000 inpatient-days in 2006 to 254.38 DDD/1,000 inpatient-days in 2010 (Coefficient = 1.13, 95%CI: 0.16-2.09, p = 0.025). Increasing utilization of carbapenems, piperacillin/tazobactam, and Gram-positive agents were seen in the majority of the hospitals, while cephalosporins were less prescribed over time. The combined expenditure for 5 hospitals increased from USD9.9 million in 2006 to USD16.7 million in 2010.
  
  
  CONCLUSIONS
  The rate of prescription of broad-spectrum antibiotics in Singaporean hospitals is much higher compared to those of European hospitals. This may be due to high rates of antimicrobial resistance. The increase in expenditure on monitored antibiotics over the past 5 years outstripped the actual increase in DDD/1,000 inpatient-days of antibiotics prescribed. Longitudinal surveillance of antibiotic prescription on a hospital and countrywide level is important for detecting trends for formulating interventions or policies. Further research is needed to understand the causes for the various prescription trends and to act on these where necessary.
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.
authors.forename: Yi-Xin
authors.initials: YX
authors.lastname: Liew
authors.forename: Prabha
authors.initials: P
authors.lastname: Krishnan
authors.forename: Chay-Leng
authors.initials: CL
authors.lastname: Yeo
authors.forename: Thean-Yen
authors.initials: TY
authors.lastname: Tan
authors.forename: Siok-Ying
authors.initials: SY
authors.lastname: Lee
authors.forename: Wan-Peng
authors.initials: WP
authors.lastname: Lim
authors.forename: Winnie
authors.initials: W
authors.lastname: Lee
authors.forename: Li-Yang
authors.initials: LY
authors.lastname: Hsu
mesh_terms: D000900:Anti-Bacterial Agents / Q000145:classification / Q000494:pharmacology*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D005102:Health Expenditures; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D011159:Population Surveillance; D012846:Singapore / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents