title: Longitudinal trends and cross-sectional analysis of English national hospital antibacterial use over 5 years (2008-13): working towards hospital prescribing quality measures.
abstract: OBJECTIVE
  There is global concern that antimicrobial resistance is a major threat to healthcare. Antimicrobial use is a primary driver of resistance but little information exists about the variation in antimicrobial use in individual hospitals in England over time or comparative use between hospitals. The objective of this study was to collate, analyse and report issue data from pharmacy records of 158 National Health Service (NHS) acute hospitals.
  
  
  METHODS
  This was a cohort study of inpatient antibacterial use in acute hospitals in England analysed over 5 years through a data warehouse from IMS Health, a leading provider of information, services and technology for the healthcare industry. Around 98% of NHS hospitals were included in a country with a population of 50 million residents.
  
  
  RESULTS
  There was a dramatic change in the usage of different groups of antibacterials between 2009 and 2013 with a marked reduction in the use of first-generation cephalosporins by 24.7% and second-generation cephalosporins by 41%, but little change in the use of third-generation cephalosporins (+5.7%) and fluoroquinolones (+1.6%). In contrast, use of co-amoxiclav, carbapenems and piperacillin/tazobactam increased by 60.1%, 61.4% and 94.8%, respectively. There was wide variation in the total and relative amounts of antibacterials used between individual hospitals.
  
  
  CONCLUSIONS
  Longitudinal analysis of antibacterial use demonstrated remarkable changes in NHS hospitals, probably reflecting governmental and professional guidance to mitigate the risk of Clostridium difficile infection. The wide variation in usage between individual hospitals suggests potential for quality improvement and benchmarking. Quality measures of optimal hospital antimicrobial prescribing need urgent development and validation to support antimicrobial stewardship initiatives.
authors.affiliation: The Centre for Infection Prevention and Management, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W12 0NN, UK Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK j.cooke@imperial.ac.uk.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cooke
authors.affiliation: IMS Health, 210 Pentonville Road, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Stephens
authors.affiliation: Healthcare-Associated Infection, Antimicrobial Resistance and Stewardship and Healthcare-Associated Infections Programme, Public Health England, London, UK.
authors.forename: Diane
authors.initials: D
authors.lastname: Ashiru-Oredope
authors.affiliation: The Centre for Infection Prevention and Management, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W12 0NN, UK.
authors.forename: Esmita
authors.initials: E
authors.lastname: Charani
authors.affiliation: Royal Hampshire County Hospital, Winchester, UK.
authors.forename: Mathew
authors.initials: M
authors.lastname: Dryden
authors.affiliation: Infectious Diseases and Blood Policy Branch, Department of Health, London, UK.
authors.forename: Carole
authors.initials: C
authors.lastname: Fry
authors.affiliation: Faculty of Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Kieran
authors.initials: K
authors.lastname: Hand
authors.affiliation: The Centre for Infection Prevention and Management, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W12 0NN, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Holmes
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Howard
authors.affiliation: Department of Healthcare-Associated Infections and Antimicrobial Resistance, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Johnson
authors.affiliation: Antimicrobial Resistance and Healthcare-Associated Infections Reference Unit, Public Health England, London, UK Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Livermore
authors.affiliation: The Care Quality Commission, London, UK.
authors.forename: Paula
authors.initials: P
authors.lastname: Mansell
authors.affiliation: Public Health England Primary Care Unit, Microbiology Department, Gloucester Royal Hospital, Gloucester, UK.
authors.forename: Cliodna A M
authors.initials: CA
authors.lastname: McNulty
authors.affiliation: Infectious Diseases and Blood Policy Branch, Department of Health, London, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Wellsteed
authors.affiliation: Healthcare-Associated Infection, Antimicrobial Resistance and Stewardship and Healthcare-Associated Infections Programme, Public Health England, London, UK Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Hopkins
authors.affiliation: Paediatric Infectious Diseases Unit, St George's Hospital, London, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D004739:England; D006291:Health Policy; D006302:Health Services Research; D006761:Hospitals; D008137:Longitudinal Studies; D055656:Prescriptions / Q000592:standards / Q000706:statistics & numerical data*; D011786:Quality Control
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotics; antimicrobial stewardship; hospital usage