How to measure hospital antibiotic consumption: comparison of two methods from data surveillance in France

Abstract

Background Antibiotic use (ABU) surveillance in healthcare facilities (HCFs) is essential to guide stewardship. Two methods are recommended: antibiotic consumption (ABC), expressed as the number of DDD/1000 patient-days; and prevalence of antibiotic prescription (ABP) measured through point prevalence surveys. However, no evidence is provided about whether they lead to similar conclusions. Objectives To compare ABC and ABP regarding HCF ranking and their ability to identify outliers. Methods The comparison was made using 2012 national databases from the antibiotic surveillance network and prevalence study. HCF rankings according to each method were compared with Spearman’s correlation coefficient. Analyses included the ABU from entire HCFs as well as according to type, clinical ward and by antibiotic class and specific molecule. Results A total of 1076 HCFs were included. HCF rankings were strongly correlated in the whole cohort. The correlation was stronger for HCFs with a higher number of beds or with a low or moderate proportion of acute care beds. ABU correlation between ABC or ABP was globally moderate or weak in specific wards. Furthermore, the two methods did not identify the same outliers, whichever HCF characteristics were analysed. Correlation between HCF ranking varied according to the antibiotic class. Conclusions Both methods ranked HCFs similarly overall according to ABC or ABP; however, major differences were observed in ranking of clinical wards, antibiotic classes and detection of outliers. ABC and ABP are two markers of ABU that could be used as two complementary approaches to identify targets for improvement.

Impacto de um programa de intervenção para uso racional de antimicrobianos associado ao diagnóstico rápido em infecções de corrente sanguínea por bacilos gram-negativos

“…Entretanto, o melhor método para quantificar o uso dos antimicrobianos ainda necessita ser melhor definido. No que diz respeito à economia de custos relacionados a gastos com antimicrobianos desnecessários como forma de avaliar o impacto do programa, o ideal é que essa economia seja atribuída não somente a gastos com a compra de antimicrobianos, mas também decorrente, por exemplo, do controle mais rápido da infecção de um menor tempo de permanência hospitalar, ou seja, com economia nos custos diretos e indiretos relacionados com o cuidado à saúde 3,4,11,[42][43][44] .…”

“…A medida da DDD por 1.000 pacientes-dia permite que um hospital compare seu uso de antimicrobianos com outros hospitais, independentemente das diferenças na composição do formulário, potência do antimicrobiano e censo hospitalar 11,[44][45][46] .…”