Abstract
BackgroundIn 2012, Israel’s National Center for Infection Control initiated a national stewardship programme that included mandatory annual reporting of antimicrobial use. Here we present nationwide Israeli data for the period 2012 to 2017.AimThe goal of this study was to detect trends in antimicrobial use in Israel following the introduction of the stewardship programme, as part of an assessment of the programme’s impact.MethodsIn this retrospective observational study, data were collected from Israel’s health maintenance organisations (HMOs), acute care hospitals and post-acute care hospitals (PACHs). Acute care hospital data were collected for general medical and surgical wards, and medical/surgical intensive care units (ICUs). Data were converted into defined daily doses (DDD), with use rates presented as DDD per 1,000 insured/day in the community and DDD per 100 patient-days in hospitals and PACHs. Trends were analysed using linear regression.ResultsAntimicrobial use decreased across sectors between 2012 and 2017. In the community, the decrease was modest, from 22.8 to 21.8 DDD per 1,000 insured per day (4.4%, p = 0.004). In acute care hospitals, antibiotic DDDs per 100 patient-days decreased from 100.0 to 84.0 (16.0%, p = 0.002) in medical wards, from 112.8 to 94.2 (16.5%, p = 0.004) in surgical wards and from 154.4 to 137.2 (11.1%, p = 0.04) in ICUs. Antimicrobial use decreased most markedly in PACHs, from 29.1 to 18.1 DDD per 100 patient-days (37.8%, p = 0.005).ConclusionBetween 2012 and 2017, antimicrobial use decreased significantly in all types of healthcare institutions in Israel, following the introduction of the nationwide antimicrobial stewardship programme.
Highlights
In 2012, Israel’s National Center for Infection Control initiated a national stewardship programme that included mandatory annual reporting of antimicrobial use
Antimicrobial stewardship (AST) aimed at curbing antibiotic-resistant bacteria may include a variety of interventions such as audits, antimicrobial use guidelines for common infectious disease syndromes and rapid diagnostic tests, and is dependent on antimicrobial use monitoring to identify and correct problematic prescribing and usage habits [9]
Following the 2012 launch by the Israeli National Center for Infection Control (NCIC) of a nationwide antimicrobial stewardship intervention [18], a decrease in antimicrobial use was observed in Israel in the community, in medical and surgical wards as well as medical/surgical intensive care units (ICUs) within acute care hospitals, and in post-acute care hospitals (PACHs)
Summary
In 2012, Israel’s National Center for Infection Control initiated a national stewardship programme that included mandatory annual reporting of antimicrobial use. Data were converted into defined daily doses (DDD), with use rates presented as DDD per 1,000 insured/day in the community and DDD per 100 patient-days in hospitals and PACHs. Trends were analysed using linear regression. An article from the country’s largest health maintenance organisation (HMO), which insures slightly more than 50% of the population, summarised antimicrobial use data in the community [13]. The largest of the studies summarised data from 26 medical wards in six hospitals between 2003 and 2004 and found an overall rate of antimicrobial use of 79.9 DDD per 100 patient-days [17], with considerable variation between wards. An article summarising data from a single Israeli hospital in 1998 found rates, expressed in DDD per 100 bed-days, of 232, 173 and 149 for intensive care units (ICUs), medical and surgical wards, respectively [16]
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