Relationship between antibiotic consumption and antibiotic policy: an adjusted analysis in the French healthcare system

In France, the public reporting of antibiotic policies in hospitals has been mandatory since 2007. Consequently, all hospitals provide to the Ministry of Health an annual follow-up of antibiotic policy. This study aimed at identifying antibiotic policy measures related to a lower antibiotic consumption. Data on antibiotic policy were extracted from the 2007 infection control indicator database in 977 acute hospitals providing antibiotic consumption data expressed in defined daily doses per 1000 patient-days (84% of all acute French hospitals). Policy data were collected using a standardized questionnaire including nine measures. From these measures, a composite score of 20 points and three policy sub-scores (organization, resource and action) were defined. Logistic regression analyses were performed using antibiotic consumption as dependent variables. Antibiotic consumption was categorized as low (< 75th percentile) or high (> 75th percentile). All models were adjusted for hospital characteristics. Hospitals had an average score of 13.8 out of 20 points.The least common antibiotic policy measures were information technology support such as a computerized link between pharmacy, laboratory and wards (39%) and information technology support for prescription (33%). Multivariable analysis showed that a high resource score was significantly associated with lower antibiotic consumption. Among measures included in the resource score, information technology support for prescription was significantly associated with lower antibiotic consumption. The odds ratio was 0.55 (95% confidence interval 0.39-0.78). Information technology support for prescription could play an important role in controlling antibiotic consumption. Further investigations should study the type of computerized prescription system to implement in hospitals.