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Surveillance Open Access
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Abstract

Background

Studies have demonstrated the link between antimicrobial consumption and the development of antimicrobial resistance. Surveillance of antimicrobial consumption is an action point of the European Commission’s ‘One Health Action Plan Against Antimicrobial Resistance’.

Aim

This study aims to compare two methodologies for antibiotic consumption surveillance, investigate the 14-year evolution of antibiotic consumption in Belgian acute care hospitals and discuss future perspectives.

Methods

We compared self-reported data (old methodology) and reimbursement data (new methodology) of national antibiotic consumption surveillance in hospitals. Descriptive analyses were performed on the reimbursement data collected per year and per trimester (2003–2016), per hospital and per unit. Antibiotic consumption was compared with European Surveillance of Antimicrobial Consumption Network (ESAC-Net) results.

Results

The median differences for defined daily doses (DDDs)/1,000 patient days and DDDs/1,000 admissions were 3.09% and 3.94% when comparing the old vs new methodology. Based on reimbursement data, the median antibiotic consumption in 2016 in 102 Belgian acute care hospitals was 577.1 DDDs/1,000 patient days and 3,890.3 DDDs/1,000 admissions with high variation between hospitals (interquartile ranges (IQR): 511.3–655.0 and 3,450.0–4,400.5, respectively), and similar to 2015. Based on DDDs/1,000 patient days, the magnitude of consumption is comparable with the Netherlands, Denmark and Sweden, but is higher when based on DDDs/1,000 admissions.

Conclusion

Antibiotic consumption in Belgian acute care hospitals has remained overall stable over time. However, the high variation across hospitals should be further investigated. This surveillance data could be used for benchmarking and assessing interventions to improve antibiotic consumption in these hospitals.

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/content/10.2807/1560-7917.ES.2019.24.46.1900098
2019-11-14
2024-03-28
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.46.1900098
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References

  1. European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance surveillance in Europe 2015. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/antimicrobial-resistance-europe-2015.pdf
  2. European Centre for Disease Prevention and Control (ECDC), European Medicines Agency (EMA). ECDC/EMA joint technical report. The bacterial challenge: time to react. Stockholm: ECDC/EMA; 2009. Available from: https://www.ema.europa.eu/en/documents/report/bacterial-challenge-time-react_en.pdf
  3. European Commission. The new EU One Health Action Plan against Antimicrobial Resistance. Brussels/Luxembourg: European Commision; 2017. Available from: https://ec.europa.eu/health/amr/action_eu_en.
  4. World Health Organisation (WHO). Antimicrobial resistance: Global Report on Surveillance. Geneva: WHO; 2014. Available from: http://www.who.int/drugresistance/documents/ surveillancereport/en/
  5. Catry B, Hendrickx E, Preal R, Mertens R. Multicentrische studie: Verband tussen antibioticaconsumptie en microbiële resistentie bij de individuele patiënt. Eindrapport IMA-BAPCOC-WIV. [Multicentre study: Link between antibiotic consumption and microbial resistance in the individual patient. Final report IMA-BAPCOC-WIV]. Brussels: IMA-BAPCOC-WIV; 2008. Dutch. Available from: http://www.nsih.be/download/AB/multicentrstudienov2008.pdf
  6. Agodi A, Auxilia F, Barchitta M, Brusaferro S, D’Errico MM, Montagna MT, et al. Antibiotic consumption and resistance: results of the SPIN-UTI project of the GISIO-SItI. Epidemiol Prev. 2015;39(4) Suppl 1;94-8. PMID: 26499423 
  7. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect Dis. 2014;14(1):13.  https://doi.org/10.1186/1471-2334-14-13  PMID: 24405683 
  8. Goossens H, Ferech M, Vander Stichele R, Elseviers M, ESAC Project Group. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet. 2005;365(9459):579-87.  https://doi.org/10.1016/S0140-6736(05)70799-6  PMID: 15708101 
  9. Belgian Antibiotic Policy Coordination Committee (BAPCOC). Beleidsnota 2014-2019. Brussels: BAPCOC. [Accessed 26 Feb 2018]. Available from: http://overlegorganen.gezondheid.belgie.be/nl/advies-en-overlegorgaan/commissies/BAPCOC
  10. National Institute for Health and Disability Insurance (NIHDI). Statistieken over personen aangesloten bij een ziekenfonds.[Statistics about persons affiliated with a health insurance fund]. Brussels NIHDI; 2016. Dutch. Available from: http://www.riziv.fgov.be/nl/toepassingen/Paginas/webtoepassing-statistieken-personen-aangesloten-ziekenfonds.aspx#.Wm8Axa7iapo
  11. Protocol Belgian Hospitals - Surveillance on Antimicrobial Consumption (BeH-SAC). Brussels: Sciensano; 2018. Available from: http://www.nsih.be/surv_gm/download_en.asp.
  12. World Health Organization (WHO) Collaborating Centre for Drugs Statistics Methodology. DDD and ATC-classification 2018. Oslo: WHO Collaborating Centre for Drugs Statistics Methodology. [Accessed 8 Aug 2018]. Available from: https://www.whocc.no/atc_ddd_index/
  13. Ingenbleek A, Van Gastel E, Costers M, Goossens M-M, Catry B, Magerman K. National report on consumption of systemic antimicrobial agents, 2007-2013. Brussels: WIV; 2015. Available from: http://www.nsih.be/surv_gm/download_en.asp
  14. Ansari F, Molana H, Goossens H, Davey P, Davey P, Ansari F, et al. Development of standardized methods for analysis of changes in antibacterial use in hospitals from 18 European countries: the European Surveillance of Antimicrobial Consumption (ESAC) longitudinal survey, 2000-06. J Antimicrob Chemother. 2010;65(12):2685-91.  https://doi.org/10.1093/jac/dkq378  PMID: 20978000 
  15. Filius PM, Liem TB, van der Linden PD, Janknegt R, Natsch S, Vulto AG, et al. An additional measure for quantifying antibiotic use in hospitals. J Antimicrob Chemother. 2005;55(5):805-8.  https://doi.org/10.1093/jac/dki093  PMID: 15814603 
  16. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals, 2016-2017. Protocol version 5.3. Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/PPS-HAI-antimicrobial-use-EU-acute-care-hospitals-V5-3.pdf
  17. Först G, de With K, Weber N, Borde J, Querbach C, Kleideiter J, et al. Validation of adapted daily dose definitions for hospital antibacterial drug use evaluation: a multicentre study. J Antimicrob Chemother. 2017;72(10):2931-7.  https://doi.org/10.1093/jac/dkx244  PMID: 29091214 
  18. Haug JB, Reikvam Å. WHO defined daily doses versus hospital-adjusted defined daily doses: impact on results of antibiotic use surveillance. J Antimicrob Chemother. 2013;68(12):2940-7.  https://doi.org/10.1093/jac/dkt268  PMID: 23838948 
  19. Ibrahim OM, Polk RE. Benchmarking antimicrobial drug use in hospitals. Expert Rev Anti Infect Ther. 2012;10(4):445-57.  https://doi.org/10.1586/eri.12.18  PMID: 22512754 
  20. Morris AM. Antimicrobial Stewardship Programs: Appropriate Measures and Metrics to Study their Impact. Curr Treat Options Infect Dis. 2014;6(2):101-12.  https://doi.org/10.1007/s40506-014-0015-3  PMID: 25999798 
  21. Henard S, Boussat S, Demoré B, Clément S, Lecompte T, May T, et al. Comparison of hospital databases on antibiotic consumption in France, for a single management tool. Med Mal Infect. 2014;44(7):308-14.  https://doi.org/10.1016/j.medmal.2014.06.001  PMID: 25015309 
  22. Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP). Use of antimicrobial agents and occurence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark. Copenhagen: DANMAP; 2016. [Accessed 8 Aug 2018]. Available from: https://www.danmap.org/Downloads/Reports.aspx.
  23. Agence nationale de sécurité du médicament et des produits de santé (ANSM). [National Agency for the Safety of Medicines and Health Products]. La consommation d'antibiotiques en France en 2016. [Antibiotic consumption in France in 2016]. Saint-Denis: ANSM. [Accessed 8 Aug 2018]. French. Available from: http://ansm.sante.fr/var/ansm_site/storage/original/application/519a5cd0c5e00867cf73dcc2ff39d519.pdf
  24. European Centre for Disease Prevention and Control (ECDC). Antimicrobial consumption interactive database (ESAC-Net) 2017. Stockholm: ECDC. [Accessed 8 Aug 2018]. Available from: https://ecdc.europa.eu/en/antimicrobial-consumption/database/rates-country
  25. Van Gastel E, Balligand E, Costers M, Magerman K, Hospital Medicine Working Group of the Belgian Antibiotic Policy Coordination Committee. Antibiotic management teams in Belgian hospitals: continued improvement in the period from 2007 to 2011. Eur J Clin Microbiol Infect Dis. 2015;34(4):673-7.  https://doi.org/10.1007/s10096-014-2279-4  PMID: 25407373 
  26. Lambert ML, Bruyndonckx R, Goossens H, Hens N, Aerts M, Catry B, et al. The Belgian policy of funding antimicrobial stewardship in hospitals and trends of selected quality indicators for antimicrobial use, 1999-2010: a longitudinal study. BMJ Open. 2015;5(2):e006916.  https://doi.org/10.1136/bmjopen-2014-006916  PMID: 25681314 
  27. National Institute of Public Health and the Environment (RIVM). NethMap 2017: Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands in 2016. Bilthoven: RIVM; 2017. Available from: https://www.rivm.nl/Documenten_en_publicaties/Wetenschappelijk/Rapporten/2017/Juni/NethMap_2017_Consumption_of_antimicrobial_agents_and_antimicrobial_resistance_among_medically_important_bacteria_in_the_Netherlands_MARAN_2017_Monitoring_of_antimicrobial_resistance_and_antibiotic_usage_in_animals_in_the_Netherlands_in_2016
  28. Public Health Agency of Sweden and National Veterinary Institute. SWEDRES/SVARM report 2016: Consumption of antibiotics and occrurance of antibiotic resistance in Sweden. Solna/Uppsala: Public Health Agency of Sweden and National Veterinary Institute; 2016. [Accessed 8 Aug 2018]. Available from: http://www.sva.se/en/antibiotics/svarm-reports
  29. Berrington A. Antimicrobial prescribing in hospitals: be careful what you measure. J Antimicrob Chemother. 2010;65(1):163-8.  https://doi.org/10.1093/jac/dkp399  PMID: 19884120 
  30. Lafaurie M, Porcher R, Donay JL, Touratier S, Molina JM. Reduction of fluoroquinolone use is associated with a decrease in methicillin-resistant Staphylococcus aureus and fluoroquinolone-resistant Pseudomonas aeruginosa isolation rates: a 10 year study. J Antimicrob Chemother. 2012;67(4):1010-5.  https://doi.org/10.1093/jac/dkr555  PMID: 22240401 
  31. Dancer SJ, Kirkpatrick P, Corcoran DS, Christison F, Farmer D, Robertson C. Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus. Int J Antimicrob Agents. 2013;41(2):137-42.  https://doi.org/10.1016/j.ijantimicag.2012.10.013  PMID: 23276500 
  32. National Institute for Health and Disability Insurance (NIHDI-RIZIV-INAMI). Nationale Databank Medische Diagnose/Zorg & Kost 2017. [National Database of Medical Diagnosis / Healthcare & Cost 2017]. City: NIHDI-RIZIV-INAMI. [Accessed 8 Aug 2018]. Dutch. Available from: https://tct.fgov.be/webetct/etct-web/html/nl/index.jsp
  33. Gharbi M, Moore LS, Gilchrist M, Thomas CP, Bamford K, Brannigan ET, et al. Forecasting carbapenem resistance from antimicrobial consumption surveillance: Lessons learnt from an OXA-48-producing Klebsiella pneumoniae outbreak in a West London renal unit. Int J Antimicrob Agents. 2015;46(2):150-6.  https://doi.org/10.1016/j.ijantimicag.2015.03.005  PMID: 25979640 
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