antibiotic consumtion in hospitals. catherine dumartin (france)
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Antibiotic consumption in hospitals:
hospital sector definition in France
Acute care hospitals and others…
February 2015
Surveillance ATB-RAISIN in France
• Objectives
To describe antibiotic consumption in French HCF at
hospital and at ward level • tool for benchmarking
• analysis of consumption data against antimicrobial resistance rates
• improvement at the hospital level and at the national level
To monitor trends
Hospital sector in France ?
Different kind of HCF
• Hospitals, public or private, with inpatients +/- outpatients
• Home-care hospitals (HAD) Part of conventional hospitals
• Dialysis centers
• Others…
Type N
CHUniversity 81
CH % acute care beds from 0 to100% 570
MCO 669
CLCC 20
HIA 9
ESSR 738
LOC now CH 255
ESLD 46
PSY 247
Total 2 636
• LTCF are not nursing homes
LTCF providing « little » medical care became
« nursing homes »
Data collection in the hospital
sector
• ESAC-Net
Hospital sector as a whole (100%): sales data from ANSM
• ATB-Raisin
Hospital-based
Voluntarily
participation (1488 in
2013)
Data collection in the hospital sector
• Scope of surveillance : All HCF with inpatients
HCF performing acute care
• Teaching or not, public or private
May include non acute care wards
• Specialised in cancer treatment
AND HCF performing non acute care
• rehabilitation centres, long term-care HCF (not NH), psychiatric centres
Data collection in the hospital sector
• In the participating HCF: Inpatients only
• Outpatient, day-care, dialysis excluded
• Detailed by ward/clinical activity (76% of HCF)
Acute care = Medicine, Surgery, ICU, gyneacology, and
paediatrics
Non acute care = rehabilitation, long-term care & psychiatry
Data collection in the hospital sector
• Rationale for scope of surveillance
• All HCF: information on prudent antibiotic use First step before tailored activity to ensure prudent use of AB
• Inpatients only: in accordance to denominator
Outpatients wards: not all HCF
ATB-Raisin participants
Type N n %
CHU 81 40 49
CH 570 393 69
MCO 669 423 63
CLCC 20 13 65
HIA 10 8 80
ESSR 738 342 46
LOC 255 125 49
ESLD 46 18 39
PSY 247 126 51
Total 2 636 1 488 56
ATB-Raisin participants
Type n No. PD %
CHU 40 11 513 046 14%
CH 393 35 722 232 43%
MCO 423 13 594 617 16%
CLCC 13 436 422 1%
HIA 8 465 618 1%
ESSR 342 10 154 373 12%
LOC 125 2 099 228 3%
ESLD 18 417 964 1%
PSY 126 8 305 309 10%
Total 1 488 82 708 809 100%
Data collection in the hospital sector
• Antibiotics for systemic use Dispensed by the pharmacy for inpatients only NB: no dispensing for discharged patients in France
• Administrative data Denominator consistent with scope of surveillance
• number of patients-days (PD) for inpatients only
“Journée d’hospitalisation” for stay > 24 h
(different from « one-day stay » < 24h)
• number of “direct” admissions (acute care only) Only one admission for one patient admitted for at least 24 h, even if transferred from
ICU to medicine
• Administrative definitions for “Journée d’hospitalisation” and “direct admission”
Data presentation
• Antibiotic consumption:
global use (pooled or weighted mean)
and distribution in no. DDD/ 1000 PD (and /100 AD for acute care wards)
According to HCF type
According to ward/clinical activity • (very) detailed tables
2008 2009 2010 2011
No. participating hospitals 861 997 1115 1262
Coverage (/ No. PD at national level) 44% 51% 52% 60%
Coverage (/ No. beds at national level) 42% 50% 52% 60%
Total antibiotic use (No. DDD/1000 PD) 369 379 374 372
020
040
060
080
010
0012
00
Teachinghospital
N=40
Nonteaching
publichospital<=33
N=73
Nonteaching
publichospital>33
N=320
NonteachingprivatehospitalN=423
Cancerhospital
N=13
Militaryhospital
N=8
Rehabcentre
N=342
Localhospital
N=125
Longtermcare
N=18
Psychiatrichospital
N=126
Num
ber
of D
DD
/ 10
00 P
D
Data presentation: ATB RAISIN, 2013
• Total antibiotic use in 1 488 HCF: 377 DDD/1000 PD
Variations in total antibiotic use according to HCF type
Outlier
Highest value still within
P75+1,5(P75-P25)
P75
Pooled mean
Median
P25
Lowest value still within
P25-1,5(P75-P25)
02
00
40
06
00
80
01
00
01
20
0
>66%N=597
]33-66%]N=222
]0-33%]N=148
0%N=521
% of acute care beds
Nu
mb
er
of
DD
D /
10
00
PD
Data presentation: ATB RAISIN, 2013
• Total antibiotic use in 1 488 HCF
Variations in antibiotic use / % acute care beds
Outlier
Highest value still within
P75+1,5(P75-P25)
P75
Pooled mean
Median
P25
Lowest value still within
P25-1,5(P75-P25)
010
0020
0030
00
Medicine
N=560
Hematology
N=25
Infectious
diseases
N=13
Surgery
N=447
Intensive
care
N=178
Gynae-
cology
N=296
Paediatrics
N=205
Rehabi-
litation
N=758
Long
term care
N=304
Psychiatry
N=211
Num
ber
of D
DD
/ 10
00 P
DData presentation: ATB RAISIN, 2013
Variations in total antibiotic use according to ward/clinical activity
Esac-Net hospital based survey
Objectives
• Comparisons of patterns, quantity between hospitals from
different countries
Relevant settings for comparisons
• acute care wards, ICUs?
• Including paediatrics?
• Inpatients only?
Challenges: exclusion of non acute care wards, of
outpatients…
More information on antibiotic use in French hospitals
http://www.invs.sante.fr/raisin
http://www.cclin-arlin.fr/