Nationwide hospital antibiotic consumption in Slovenia

Abstract

Sir, Data on hospital antibiotic consumption at national, hospital and ward levels are scarce. Recently, France reported a first survey of hospital consumption of antibiotics representing 29.3% of their hospital beds at the hospital and ward level. Since 2004 Slovenia has regularly monitored antibiotic consumption at a national level, as well as at the level of different hospital types, and at the ward level since 2006. The consumption of antibiotics is monitored in the same type of hospitals as in France. Slovenia has 29 hospitals, and in 2007 that amounted to 9414 hospital beds. The number of bed-days (patient-days) was 2485493; the mean length of stay was 6.8 days. In the same year the overall consumption of antibiotics for systemic use (J01) according to the WHO Anatomical Therapeutic Chemical (ATC) classification and WHO version 2007 [without oral nitroimidazole derivatives (P01AB)+rifampicin (J04AB02)] was 50.4 defined daily doses (DDDs)/100 bed-days, 324.2 DDDs/100 admissions and 1.69 DDDs/1000 inhabitants/day. Oral nitroimidazole derivatives and rifampicin represented 4.5% of total use in France. The consumption in teaching and general hospitals was 59.4 (50.6–68.8) DDDs/100 bed-days. France has lower consumption expressed in DDDs/100 bed-days than Slovenia, but if we express data in DDDs/1000 inhabitants/day the relationship is reversed. The consumption expressed in DDDs/100 bed-days is different from the data expressed in DDDs/1000 inhabitants/day when we compare the data in France, the Netherlands, Sweden, Denmark and Slovenia (Table 1). It appears that the expression of hospital use in DDDs/ 1000 inhabitants/day does not parallel completely with DDDs/ 100 bed-days and DDDs/100 admissions. In 2007 Slovenia had 464 hospital beds/100000 inhabitants compared with 718 in France. This provides an explanation for the apparent discrepancy in DDDs/1000 inhabitants/day versus DDDs/100 bed-days. The consumption of antibiotics with oral imidazole derivatives (metronidazole) and rifampicin (80% of hospitals provided data) at the ward level in Slovenian hospitals is higher than in France: internal medicine wards, 65.3 versus 58.3 DDDs/100 bed-days; intensive care units, 190.9 without J04AB02 and P01AB versus 146.6 DDDs/100 bed-days; paediatric wards, 41.7 versus 33.3 DDDs/100 bed-days; and gynaecology wards, 31.03 versus 30.8 DDDs/100 bed-days. Lower consumption was observed in Slovenian surgical wards, with 55.2 versus 55.3 DDDs/100 bed-days. The consumption varied substantially among different types of hospitals as well as among hospitals and wards of the same type. The most common classes of antibiotics prescribed in France in 2007 were combinations of penicillins with b-lactamase inhibitors (J01CR) followed by extended-spectrum penicillins (J01CA), fluoroquinolones (J01MA) and cephalosporins (J01DB–DE). Cephalosporins and fluoroquinolones are also among the four most prescribed classes in Sweden, the Netherlands, Denmark and Slovenia. Among the four most prescribed classes were extended-spectrum penicillins in Denmark and the Netherlands, macrolides and lincosamides in Slovenia, tetracyclines in Sweden, b-lactamase-sensitive penicillins in Denmark and b-lactamase-resistant penicillins in Sweden. 6 Countries (France and Slovenia) with higher use of third-generation cephalosporins have higher rates of resistant invasive isolates of Klebsiella pneumoniae resistant to third-generation cephalosporins than countries in which second-generation cephalosporins are the most commonly prescribed cephalosporins (http:// www.ecdc.europa.eu/en/publications/Publications/Forms/ECDC_ DispForm.aspx?ID=580). Small countries are able to monitor hospital antibiotic consumption in all hospitals. To plan public health actions we need sustained monitoring of antibiotic use on a national stage, meaning at both the hospital and ward levels. The benchmarking of data provides useful information to assess relative