Antibiotic Use in Hospitals: Results from a Surveillance Network in 530 French Hospitals, 2007

Background: Antibiotic (AB) use in French hospitals is among the highest in Europe. To improve AB use, French hospitals are required to implement AB stewardship programmes including surveillance of AB consumption.

Objective: A study was carried out by the regional nosocomial infection control coordinating centers to describe AB consumption at hospital and at ward levels and to provide tools for benchmarking.

Methods: Antibacterials for systemic use (class J01 of WHO Anatomical Therapeutic Chemical classification, ATC-DDD system, 2007) were surveyed. In addition, rifampicin and oral imidazole derivatives were included to better assess total AB exposure. Data were retrospectively collected by 530 voluntary hospitals accounting for almost 30% of French hospitals beds, with around 40 million patient-days (PD): 27 teaching hospitals, 323 non-teaching hospitals, 10 cancer hospitals, 86 rehabilitation centers, 39 local hospitals, 45 long term care (LTC) and psychiatric hospitals. AB consumption for inpatients, expressed in number of defined daily doses (DDD) per 1,000 PD, and number of PD in 2007, were collected for the whole hospital and detailed in 357 hospitals for each clinical activity: medicine, surgery, intensive care units (ICU), gynaecology, paediatrics, rehabilitation, LTC and psychiatry.

Results: Median AB use ranged from 60 DDD/1,000 PD in LTC and psychiatric hospitals to 633 in teaching hospitals, with variations among hospitals belonging to the same group. Level of consumption and pattern of use differed according to clinical activities in hospitals: 60 in psychiatric wards, 213 in rehabilitation, 308 in gynaecology, 333 in paediatrics, 553 in surgery, 583 in medicine, to 1466 in ICU. Amoxicillin-clavulanic acid had the highest consumption level, except in paediatrics and gynaecology where amoxicillin had. In medicine, surgery, ICU and rehabilitation wards, fluoroquinolones accounted for 13% to 19% of total use. Among similar wards, variations were seen in both the volume of AB use and their distribution.

Conclusions: This multicenter survey provided detailed information on AB use in a large sample of hospitals and wards, allowing relevant comparisons and benchmarking. Analysis of consumption at ward level should help hospitals to target practice audits on AB use. This surveillance network brings additional information to available data on antimicrobial resistance surveillance and practice audits, that are useful for hospitals, as shown by an increase participation in 2008 (861 hospitals, preliminary data). At regional and national level, these data are useful for policy-maker to better steer policies. From 2010, this surveillance network will be run by the national RAISIN network, along with surveillance of HCAI and multidrug resistant bacteria.