Hospital antibiotic use in Norway. Epidemiology and surveillance methodology.
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AbstractEffective antibiotics have been available for humans only the last 70 years and have been a prerequisite for the success of modern medicine. A strong correlation exists between inappropriate use of antibiotics and development of antibiotic resistance. Presently, a worldwide surge in resistance poses one of the most serious threats to global public health. Antibiotic resistance has been low in Norway but little is known about the extent of antibiotic use in hospitals. Our aim was to analyse the pattern and temporal trends of antibiotic use and to evaluate appropriate methods for a routine antibiotic surveillance. For eight Health Enterprises (HEs), from 2002 to 2007 there was an increase in total use of antibiotics of 18% measured as WHO defined daily doses (WHO DDDs) per 100 bed days, while broad-spectrum antibiotics increased by 48%. The increases were even more pronounced for medical, surgical and intensive care departments (26% and 60%). An important conclusion was that when surveillance results are reported the amounts of antibiotics should be related to both the number of bed days and the number of discharges. In another data set of all 22 Norwegian HEs for the period 2006–2011, we first showed that for hospital patients WHO DDDs for several antibiotics were set too low, particularly so for penicillins. The data were re-analysed using hospital-adjusted doses (haDDDs), which were the doses recommended in hospital guidelines. Surveillance results were substantially altered when the haDDDs were applied rather than the WHO DDDs, most importantly revealing a more pronounced broad-spectrum antibiotic use. With use of a multivariate linear regression model we then investigated patient- and hospital-related factors that might affect the use of antibiotics in hospitals. The factors identified were mostly non-modifiable. A residual variance (30% –50% for all antibiotics; 50% – 70% for broad-spectrum antibiotics) were not explained, and are probably prescriber-related.
List of papers
|1. Pharmacy sales data versus ward stock accounting for the surveillance of broadspectrum antibiotic use in hospitals. Haug JB, Myhr R, Reikvam Å. BMC Medical Research Methodology 2011; 11(1): 166. This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens. The published version is available at: https://doi.org/10.1186/1471-2288-11-166|
|2. Increased antibiotic use in Norwegian hospitals despite a low antibiotic resistance rate. Haug JB, Berild D, Walberg M, Reikvam Å. Journal of Antimicrobial Chemotherapy 2011; 66(11): 2643-6. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1093/jac/dkr361|
|3. WHO defined daily doses versus hospital adjusted daily doses: impact on surveillance results of antibiotic use. Haug JB, Reikvam Å. Journal of Antimicrobial Chemotherapy 2013; 68(12): 2740-2747. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1093/jac/dkt268|
|4. Hospital- and patient-related factors associated with differences in hospital antibiotic use: analysis of national surveillance results. Haug JB, Berild D, Walberg M, Reikvam Å. Antimicrobial Resistance and Infection Control 2014, 3:40. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. The published version is available at: https://doi.org/10.1186/s13756-014-0040-5|