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Abstract
To assess 8-year antibiotic consumption and expenditure in all of the hospitals of Emilia Romagna. The analysis was based on the pharmacy records of each hospital. Antibiotic drug consumption was expressed as DDDs per 100 bed-days used (BDU) and data were analyzed according to ATC classification and to single wards. Expenditure was expressed as Euros per 100 BDU. In the 8-years considered, overall consumption increased by 27% and expenditure by only 3%. Consumption was higher in surgical wards than in medical ones. Penicillins and β-lactamase inhibitors ranked first, followed by fluoroquinolones and third generation cephalosporins. The results of the study strongly suggest that antibiotic use could be improved by educational interventions to improve clinical practice in hospitals, assessments of guidelines and monitoring of the outcomes of the interventions are needed.
Acknowledgements
We thank the Drug Policy Service of Emilia-Romagna Region for kindly supplying hospital pharmacy record data from the Emilia-Romagna Health Authority Database.
Financial & competing interests disclosure
This research was supported by a grant from the Emilia-Romagna Region Health Authority. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of this manuscript.
Key issues
Several authors reported the increasing use of antibiotics and the consequent raising of antibacterial resistance.
The European CDC aimed at strengthening Europe's defenses against infectious diseases and at providing scientific relevant information and best practices to facilitate the correct use of antibiotics. Easy access to antibiotics increases exposure to these drugs as well as bacterial resistance which, without a more rational prescribing practice, will become an uncontrolled problem affecting the wider population.
There are differences between medical and surgical areas in the Emilia-Romagna hospitals. According to the most recent guidelines, perioperative antibiotic prophylaxis in adults is not always required and high consumption data, especially in surgical area, may suggest antibiotic overuse and require further surveys.
Antibiotics use increased in almost all wards, but it grew sharply in the wards of the intensive care and pediatrics units according to a few European studies. In this study, high antibiotic consumption in pediatrics surgery is in contrast with a point prevalence survey of 2008, which involved 32 European hospitals, but it is difficult to determine whether antibiotics in pediatric for surgical prophylaxis had an excessive use in Emilia-Romagna hospitals.
HIV-infected patients, by themselves, do not justify the high antibiotic consumption recorded in infectious disease wards of Emilia-Romagna hospitals.
Antibiotics are an essential tool for modern medicine and common procedures such as transplantation, chemotherapy for cancer and even orthopedic surgery could not be performed without the availability of potent antibiotics. The inappropriate choice of antibiotics could be considered as one of the causes of the increased costs of therapy and of ecological consequences, such as the resistance development.
In this context, prudent antibiotic use and comprehensive infection control strategies targeting all healthcare sectors (hospitals, long-term care facilities and ambulatory care) are the cornerstones of effective interventions aiming to prevent selection and transmission of antibiotic-resistant bacteria. Recognition of the most successful approaches by our institutions and by health system to ensure adherence to antibiotic use policies are needed.