title: Systematic review of antibiotic consumption in acute care hospitals.
abstract: Antibiotic consumption is an easily quantifiable performance measure in hospitals and might be used for monitoring. We conducted a review of published studies and online surveillance reports reporting on antibiotic consumption in acute care hospitals between the years 1997 and 2013. A pooled estimate of antibiotic consumption was calculated using a random effects meta-analysis of rates with 95% confidence intervals. Heterogeneity was assessed through subgroup analysis and metaregression. Eighty studies, comprising data from 3130 hospitals, met the inclusion criteria. The pooled rate of hospital-wide consumption was 586 (95% confidence interval 540 to 632) defined daily doses (DDD)/1000 hospital days (HD) for all antibacterials. However, consumption rates were highly heterogeneous. Antibacterial consumption was highest in intensive care units, at 1563 DDD/1000 HD (95% confidence interval 1472 to 1653). Hospital-wide antibacterial consumption was higher in Western Europe and in medium-sized, private and university-affiliated hospitals. The methods of data collection were significantly associated with consumption rates, including data sources, dispensing vs. purchase vs. usage data, counting admission and discharge days and inclusion of low-consumption departments. Heterogeneity remained in all subgroup analyses. Major heterogeneity currently precludes defining acceptable antibiotic consumption ranges in acute care hospitals. Guidelines on antibiotic consumption reporting that will account for case mix and a minimal set of hospital characteristics recommending standardized methods for monitoring and reporting are needed.
authors.affiliation: Internal Medicine B, Rambam Health Care Campus, Haifa, Israel. Electronic address: ro_oren@rambam.health.gov.il.
authors.forename: R
authors.initials: R
authors.lastname: Bitterman
authors.affiliation: Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.
authors.forename: K
authors.initials: K
authors.lastname: Hussein
authors.affiliation: Internal Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Leibovici
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Israel; Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Carmeli
authors.affiliation: Division of Infectious Diseases, Rambam Health Care Campus, Haifa, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Paul
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D004363:Drug Utilization; D005060:Europe; D006761:Hospitals; D006801:Humans; D012107:Research Design / Q000592:standards
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic consumption; antibiotic use; carbapenems; meta-analysis; systematic review