Antibiotic use optimization program in the largest Croatian university hospital: benefits of restrictions on unlimited antibiotic use

Likić, Robert and Francetić, Igor and Bilušić, Marinko and Erdeljić, Viktorija and Makar-Aušperger, Ksenija and Junačko, Carmen and Šimić, Petra (2007) Antibiotic use optimization program in the largest Croatian university hospital: benefits of restrictions on unlimited antibiotic use. Collegium Antropologicum, 31 (1). pp. 241-246. ISSN 0350-6134

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Abstract

The aim of this study was to obtain the relevant information on antibiotic use in a 750-bed Croatian university hospital. The study has been designed as a 2-point prevalence interventional analysis. For each patient on antibiotic therapy, diagnosis, indication for treatment, antibiotic therapy, dosage and route of administration together with the results of microbiological studies (if available) were obtained. After the first prevalence analysis in 2001, a restriction on unlimited antibiotic use was introduced. The second analysis, performed in 2002, after restrictions on antibiotic use, revealed reductions in the rates of restricted release antibiotics and overall antibiotic use with decreases from 38.6% to 36.9% and 23.4% to 23.2% respectively (p = 0.87). The first survey showed that the 5 most often prescribed antibiotics in the therapy of bacterial infections were: gentamicin, other aminoglycosides, carbapenems, amoxycillin +clavulanate and vancomycin with proportions of 14.8%, 10.3%, 8.2%, 7% and 7% respectively. In the year 2002, the most prescribed antimicrobial drugs in the therapy of bacterial infections were: gentamicin, quinolones, vancomycin, carbapenems and cefuroxime with proportions of 18.6%, 11.4%, 9.7%, 9.3% and 8% respectively. A reduction in the proportions of doubtful antibiotic therapy, from 24.6% before the intervention, to 24.2% after the restrictions, accompanied by a 0.4% rise in the rates of indicated antibiotic therapy was also observed (p = 0.93). Our study shows that restrictions on formerly unlimited use of antimicrobials, even when leading to an improvement in their prescribing, do not necessarily cause rapid and significant reduction in the overall use of antibiotics or explicit positive financial effects.

Abstract in Croatian

Svrha ovog istraživanja bila je sakupiti relevantne informacije o upotrebi antimikrobnih lijekova u hrvatskoj sveučilišnoj bolnici sa 750 kreveta. Istraživanje je dizajnirano kao intervencijska analiza s 2 točke prevalencije. Za svakog bolesnika na antimikrobnoj terapiji sakupljeni su podaci o antimikrobnoj terapiji, dijagnozi, indikaciji za terapiju, dozi i putu primjene lijeka zajedno s rezultatima mikrobiološke obrade (ukoliko su bili dostupni). Nakon analize prve točke prevalencije u 2001. godini, uvedena je restrikcija na neograničeno propisivanje antimikrobnih lijekova. Druga analiza, provedena 2002, nakon uvedenog ograničenja na antimikrobne lijekove, pokazuje smanjenje postotka upotrebe antimikrobnih lijekova s ograničenim propisivanjem s 38.6% na 36.9% te smanjenje upotrebe svih antimikrobnih lijekova s 23.4% na 23.2% (p=0.87). U prvom istraživanju pet najpropisivanijih antimikrobnih lijekova u terapiji bakterijskih infekcija su bili: gentamicin (14.8%), drugi aminoglikozidi (10.3%), karbapenemi (8.2%), amoksicilin s klavulanskom kiselinom (7%) i vankomicin (7%). U 2002. godini, najpropisivaniji lijekovi u terapiji bakterijskih infekcija bili su: gentamicin (18.6%), kinoloni (11.4%), vankomicin (9.7%), karbapenemi (9.3%) i cefuroksim (8%). Također je zabilježeno smanjenje postotka upitne antimikrobne terapije, s 24.6% prije intervencije, na 24.2% nakon restrikcija, uz 0.4% porast udjela indicirane antimikrobne terapije (p=0.93). Naše istraživanje pokazuje da restrikcije na prethodno neograničenu upotrebu antimikrobnih lijekova, čak i kada dovode do poboljšanja u njihovu propisivanju, ne uzrokuju nužno brzo i značajno smanjenje ukupne potrošnje antimikrobnih lijekova ili jasno pozitivne financijske učinke.

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