4CPS-247 Variations in consumption of antimicrobials in internal medicine wards of hospitals

Abstract

Background and importance Although there is a direct relationship between rates of antibiotic use and emergence of antimicrobial resistance in the community and in hospital, measurement of antimicrobial consumption, without further analysis of any variations observed, is inadequate to support decision making. Aim and objectives The aim of the study was twofold: presenting variations in antimicrobial consumption in internal medicine wards and investigating potential variables in the choice of regimen. Material and methods Anonymous data on administration of parenteral antibiotics, during 2019, in two internal medicine wards of a general hospital and one semi-autonomous (independent) internal medicine clinic, located in the same healthcare region, were collected and compared. Antibiotic consumption was recorded as daily defined doses per 100 bed days (DDDs/100 bed days). All antibacterial antibiotics were included in the analyses. Furthermore, each substance’s contribution, as a percentage of the annual configuration of the total index, was calculated. Average length of stay (LOS) and regimen indications were also registered. Results In 2019, total antibiotic consumption in the general hospital internal medicine clinics ranged from 176.53 to 184.03 DDDs/100 bed days, exhibiting a 4.5-fold difference compared with the independent clinic. Administration of 33 and 35 different antibiotics, respectively, was recorded in the general hospital clinics versus 25 in the independent clinic. Ampicillin/sulbactam, meropenem and piperacillin/tazobactam (with minor differences observed) were more often used in the general hospital, while meropenem, piperacillin/tazobactam and clindamycin were used most in the independent one. Despite the differences, the relative contribution of different antibiotics to total consumption was comparable for piperacillin/tazobactam, meropenem and ceftriaxone in all cases. Variables in the choice of regimen were mainly patient age, LOS and antibiogram. Average LOS was 10 days versus 25 days between hospitals. More than 90% of admissions in the general hospital (vs 5%) were emergency admissions. Conclusion and relevance Only small differences in antimicrobial regimens were observed within each hospital, whereas between hospitals they varied significantly. Variables related to the general hospital environment, such as the increased probability of multiresistant pathogens (suggesting concomitant administration of two or more antibiotics) and the intensive care profile may adequately explain the observed variations. Such variables should always be considered in antibiotic stewardship programmes and/or other initiatives. References and/or acknowledgements Conflict of interest No conflict of interest