ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
4. ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
The University Medical Centre Ljubljana (UMC) is the only tertiary care centre in Slovenia. In 2001 the UMC had 2,455 beds and admitted 82,594 patients, who stayed in hospital for a total of 582,745 bed-days, the average length of stay being 7.0 days. An open drug formulary is used for all drugs in the centre.
In the period from 1995 to 1997, the consumption of antibacterial drugs in the UMC (including psychiatric units which accounted for approximately 25% of bed-days) increased by 5.9%, attaining 43.68 DDD/100 bed-days in 1997 (Vipintin and #ipman, 1998). -lactam agents were the most commonly used antimicrobials (53%), followed by macrolide and lincosamide antibiotics (13%), and quinolones (12%) (Vipintin and #ipman, 1998). In most units, a trend towards increasing use of macrolides, lincosamides, and quinolones was associated with a marked decline in the use of tetracyclines and amphenicols.
The utilization of some problem antibiotics in the UMC has been regulated since 1998. The original list of so-called restricted agents, drawn up by the antibi- otic committee, included 11 antibacterials and 1 antifungal drug (lipid associated forms of amphotericin B). Any drug from the list may be prescribed only on approval of ID or a few members of the antibiotic committee. A special order form, including data on the patient, type of infection or prophylaxis, and dosage is used for these drugs. Exceptionally, the use of an antibiotic from the list may be approved by telephone on the basis of previous consultation. The utilization of these antibiotics in individual hospital departments is monitored by a team of two ID doctors. Several departments may be covered by one team. Other common measures such as stop orders, systematic education of physicians, auditing, com- puter guided prescription, or rotation of antibiotics (Gould, 1999, 2002; Keuleyan and Gould, 2001; Struelens et al., 1999; van der Meer and Gyssens, 2001; Wilton et al., 2002) have not been used in the UMC. Unfortunately, the hospital manage- ment shows inadequate understanding of problems of antibiotic consumption and bacterial resistance and so most of the work in this field is done on a voluntary basis by a handful of enthusiasts. The consumption of antibacterials in the UMC from 1998 to 2002 is presented in Figure 1.
The data in Figure 1 show a 9% increase in the total consumption of antibacterials (from 58.91 to 64.31 DDD/100 bed-days) in the period from 1998 to 2002. The highest increase was observed in fluoroquinolones (64%),
258 Milan Cˇizˇman and Bojana Beovic´
70 AMPHENICOLS
3.04 2.27 60 3.82 3.87 4.01 2.5 3.73 3.51 4.25 5.13 TETRACYCLINES 3.82
4.19 4.53 5.31 50 4.28 7.09 8.2 SULFONAMIDES AND 7.02 7.42 TRIMETHOPRIM 6.7 11.66 AMINOGLYCOSIDE 40 7.73 8.79 9.46 ANTIBACTERIALS 7.11 OTHER ANTIBACTERIALS
30 10.13 11.49 DDD/100 bed-days 13.71 13.39 12.48 MACROLIDES, LINCOSAMIDES AND STREPTOGRAMINS
20 QUINOLONE ANTIBACTERIALS
22.98 OTHER BETA-LACTAM ANTIBACTERIALS
BETA-LACTAM 0 ANTIBACTERIALS,
Figure 1. Consumption of antibiotics in the UMC Ljubljana (DDD/100 bed-days)
followed by macrolides and lincosamides (9%), and other -lactam antibacte- rials (33%). The consumption of penicillins was stable, whereas the consump- tion of other antibacterials, aminoglycosides, TMP/SMX, tetracyclines, and amphenicols decreased. The consumption of restricted antibiotics varied from
2.93 DDD/100 bed-days in 1998 to 2.77 DDD/100 bed-days in 1999, 3.76 DDD/100 bed-days in 2001, and 3.39 DDD/100 bed-days in 2002. In the same period, the average length of hospital stay declined from 7.9 days in 1998 to
7.3 days in 2002. Since restricted antibacterials accounted for only 5% of all antibiotic consumption in the centre, the institution of restrictive measures for this group of antibiotics could not influence significantly the total consump- tion of antibitiotics in the hospital. Consequently, a decrease in the total use of antibiotics was observed only in a few departments where ID specialists were responsible for the treatment of all bacterial infections (Beovic´ et al., 2003). On the other hand, restricted antimicrobials represent approximately a third of the total cost of antimicrobial agents in the centre. Therefore the restrictions may be expected to have a significant financial impact, besides helping to reduce the development of resistant organisms (White et al., 1997).
Parts
» Antibiotic Policies: Theory and Practice
» THEORIES OF FACILITATING CHANGE
» OTHER APPROACHES TO GUIDELINE DEVELOPMENT
» QUALITY ASSURANCE AND DEVELOPMENT OF STANDARDS
» DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
» WHICH QI INTERVENTIONS HAVE BEEN STUDIED IN CAP?
» LINKING PROCESS OF CARE TO OUTCOMES IN QI
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE PROCESS OF CARE IN CAP?
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE OUTCOMES IN CAP?
» Designing and implementing a CAP intervention
» LEVEL OF AGGREGATION OF ANTIMICROBIALS
» ANTIMICROBIAL USAGE MEASURES
» Relationships based on patient-specific data
» Relationships based on aggregate usage
» ANTIBIOTIC CONSUMPTION; ALTERNATIVE UNITS OF MEASUREMENT
» ANTIBIOTIC CONSUMPTION CALCULATOR
» BENCHMARKING FOR REDUCING VANCOMYCIN USE AND VANCOMYCIN- RESISTANT ENTEROCOCCI IN US ICU S
» THE HARVARD EMERGENCY DEPARTMENT QUALITY STUDY
» ANALYSIS BY INDIVIDUAL ANTIMICROBIAL AGENT
» BENCHMARKING WITH OTHER ANTIMICROBIAL UTILISATION DATA
» STATE OF THE ART OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» AUDITING AND IMPROVING THE QUALITY OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» TYPES OF STUDIES TO OBTAIN QUALITY DATA ON A PATIENT LEVEL
» MULTIDISCIPLINARY ANTIMICROBIAL MANAGEMENT TEAMS
» THE ROLE OF THE PHARMACIST IN INFECTION MANAGEMENT
» TRAINING AND SUPPORT IN INFECTION MANAGEMENT FOR PHARMACISTS
» ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
» ANTIBIOTIC CONSUMPTION IN ICU S
» ANTIBIOTIC RESISTANCE IN ICU
» The impact of antibiotic policies and antibiotic consumption on antibiotic resistance
» IT and benchmarking to improve antibiotic prescribing
» COST OF HOSPITAL-ACQUIRED INFECTION
» THE COST OF ANTIMICROBIAL RESISTANCE
» Costs of screening/surveillance cultures
» Isolation, cohorting, and contact isolation
» EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS
» Antifungal resistance in Candida species
» Antifungal resistance cannot be transmitted by extrachromosomal DNA
» RATIONAL USE OF ANTIFUNGAL AGENTS
» THE CHANGING FACE OF VIRAL INFECTIONS AND THEIR MANAGEMENT
» PROBLEMS ASSOCIATED WITH ANTIVIRAL THERAPY
» ANTIVIRAL TREATMENT STRATEGIES
» ANTIVIRAL PROPHYLAXIS STRATEGIES
» ANTIBIOTIC CONCENTRATIONS AT TARGET SITES
» An infant with aplastic anaemia
» A long-standing E. coli infection of liver cysts
» BREAKPOINTS: A SHORT HISTORY AND OVERVIEW
» PHARMACODYNAMIC RELATIONSHIPS AND EMERGENCE OF RESISTANCE
» EVALUATION OF THE ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA PUBLISHED IN THE MEDICAL LITERATURE
» PRACTICAL ASPECTS OF THE IMPLEMENTATION OF THE SURVEILLANCE PROGRAM
» Multivariate analysis methods
» Evolutionary genetic approaches
» Study of the relationship between bacterial resistance and antimicrobial consumption
» To predict the short-term evolution of resistance
» To evaluate interventions to control antibiotic resistance
» DISINFECTANTS: TYPES, ACTIONS, AND USAGES
» Evidence of bacterial resistance to biocides
» Mechanisms of bacterial resistance to biocides
» EVIDENCE OF CROSS-RESISTANCE BETWEEN BIOCIDES AND ANTIBIOTICS
» DISINFECTANT USAGE AND ANTIBIOTIC RESISTANCE
» METHODS OF LITERATURE REVIEW
» PROBLEMS WITH INTERPRETATION OF PUBLISHED STUDIES
» Distribution of educational materials
» Audit and feedback with or without other educational materials
» Educational group meetings or seminars
» Educational outreach/academic detailing
» Financial/healthcare system changes
» EFFECT OF INTERVENTIONS ON ANTIBIOTIC RESISTANCE
» DDD/1,000 INHABITANTS AND DAY (DID)
» PRESCRIPTIONS/1,000 INHABITANTS AND YEAR
» INDICATIONS FOR ANTIBIOTIC PRESCRIPTIONS
» POSSIBLE CAUSES FOR OBSERVED VARIATIONS IN ANTIBIOTIC USE
» DETERMINANTS OF ANTIBIOTIC CONSUMPTION
» COLLECTIVE AWAKENING AND PROGRESSIVE MOBILIZATION OF FRENCH PUBLIC HEALTH AUTHORITIES
» ANTIBIOTIC USE AND COST TRENDS
» IMPACT ON HEALTH BUDGETS OF ANTIBIOTIC USE
» ACCESS TO ESSENTIAL ANTIBIOTICS AT ALL LEVELS OF CARE
» EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE
» THREAT OF ANTIMICROBIAL RESISTANCE
» ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
» FACTORS CONTRIBUTING TO DEVELOPMENT AND SPREAD OF RESISTANCE
» STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
» Antibacterial resistance and policies
» Policies, guidelines, and education on antibacterial use
» Discovery, development, and commercialization in the face of policies
» Antibacterial development, labelling, and benefits
» WHAT CAN BE DONE NOW ABOUT ANTIBIOTIC RESISTANCE?
» HOW CAN THE DIAGNOSTIC LABORATORY HELP?
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