Antimicrobial consumption in a tertiary children’s hospital in Finland (2003–2013)

Abstract

Background Numbers of resistant pathogens are constantly increasing, and prudent use of antimicrobials is of paramount importance. In order to see whether any changes in the use of antimicrobials in recent years have occurred, we decided to monitor the consumption of these drugs at a single tertiary paediatric hospital. Materials and methods This single-centre retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical /DDD index) in a 130-bed paediatric tertiary hospital. The data on the consumption of antimicrobials were collected from years 2003-2013 by using electronic surveillance records provided by the local pharmacy. The consumption was related to days of hospital care. Results During 2003-2013, the use of penicillins, cephalosporins and carbapenems increased by 28%, 46% and 110%, respectively. The consumption of both aminoglycosides and vancomycin decreased by 61% and 41%, respectively. Amphotericin B use clearly decreased by 39% while the use of novel azoles and echinocandins increased. Conclusions Increased use of carbapenems was the most significant finding of our study. The year-to-year consumption of antibacterials was in general relatively stable and new antibacterials were taken into use conservatively. In contrast to antibacterials, novel antifungals were rapidly adopted into use despite scarce evidence on their safety in children. INTRODUCTIONInvestigating and monitoring the consumption of antimicrobials in hospitals is necessary in order to encourage prudent use of these drugs. The use of broad spectrum antibacterials is a potential problem. It causes selection pressure and may lead to increasing numbers of resistant pathogens. In addition, such use of antibacterials most probably also causes difficult secondary infections. Similarly, local knowledge on the use of antimicrobials is crucial and allows us to implement necessary measures to support appropriate use of antimicrobials.When investigating the consumption of antimicrobials, defined daily doses (DDDs) can be used. DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.3 4 Numerous studies have investigated the consumption of antimicrobials in hospitalised adult patients by using DDDs, 5-8 but such studies in paediatric patients are in large scale missing.There are obvious obstacles when using DDDs in children. The most important being that the paediatric population is a very heterogeneous group with great variation in weight and age. Thus, comparing neonatal use with that of the adolescents is very challenging. The DDDs may, however, be used to describe paediatric consumption of individual antimicrobials over a certain period of time in a setting where no major changes in the hospital clientele took place.We have studied the consumption of these drugs in the Children's Hospital, University of Helsinki, by using DDDs as parameters of antibiotic use. The overall age bands of our patients have stayed...

Seasonality and Annual Utilization Patterns of Antibacterials at Muhimbili National Hospital, Dar es Salaam, Tanzania: A 2015 Monthly Survey

“…Our study indicated high use of quinolones, azoles, and penicillins, contrary to a hospital-based study in Finland from 2003 to 2013, which revealed an increase in penicillins, cephalosporins and carbapenems (31). Frequent use of cephalosporins was observed in Ethiopia (21).…”

Observational Study of Antibiotic Usage at the Children’s Clinical University Hospital in Riga, Latvia

“…Laine et al [ 25 ] found a reduction in the consumption in penicillin G in their hospital in 2011–2012 which took place at the same time pneumococcal conjugate vaccine was introduced to the national immunization program in Finland (at 2010). We also had a reduction in the consumption of penicillin G at the same time.…”

Antibiotic consumption and healthcare-associated infections in a tertiary hospital in Belgrade, Serbia from 2011 to 2016

“…The MMA is a 1200-bed tertiary healthcare centre with 27 departments. The Ethics Committee of the MMA approved the research protocol (Project MF/VMA/02/ [17][18][19].…”

“…The J01 antibacterials included in this study were the following: J01A tetracyclines (J01AAtigecycline), J01C beta-lactam antibacterials, penicillins (J01CA-ampicillin, J01CGampicillin/sulbactam, J01CE-benzilpenicillin sodium/procainbenzilpenicillin, J01CRamoxicillin/clavulanic acid, piperacillin/tazobactam), J01D other beta-lactam antibacterials (J01DBcefazolin, J01DC-cefuroxime, J01DD-cefotaxime, ceftazidime, ceftriaxone, J01DE-cefepime; J01DHcarbapenems), J01E sulfonamides and trimethoprim (J01EE-sulfametoxazol and trimethoprim), J01F macrolides, lincosamides and streptogramines (J01FAerythromicyn, azithromycin, J01FF-clindamycin), J01G aminoglycoside antibacterials (J01GBgentamicin, amikacin), J01M quinolone antibacterials (J01MA-ciprofloxacin, levofloxacin), J01X other antibacterials (J01XA-vancomycin, teicoplanin, J01XB-colistin, J01XD-metronidazole). The prescription of antifungal and antiviral drugs was excluded from the study [17]. According the patients' risk of developing CDI, antibiotics are grouped as: high risk-antibiotics (ATC codes: J01D, J01M and J01FF), medium-risk antibiotics (ATC codes: J01C, J01E, J01FA and J01G) and a low-risk antibiotics (ATC code: J01A) [5].…”

“…The use of prescribed daily doses (PDDs) is nowadays widely used for measuring antibiotic consumption in hospitals because it will give the amount of a drug that has actually been prescribed. Some authors think that there are discrepancies between the two methods [17,36]. Obviously, additional research is needed to determine which method should be used for calculation of antibiotic usage.…”