Antibiotic usage in German hospitals: results of the second national prevalence study

Objectives: Data on antibiotic usage (AU) are helpful for improvement of antibiotic stewardship. This study describes findings and targets for quality improvement in German hospitals identified in a national point prevalence survey of healthcare-associated infections and AU. Methods: The survey was organized by the German National Reference Centre for Surveillance of Nosocomial Infections (NRZ) as part of a pan-European survey organized by the European Centre for Disease Prevention and Control (ECDC). Infection control personnel of participating hospitals were trained in methodology and performed the survey in September and October 2011. Data on the antimicrobials prescribed (e.g. compounds and indications) were analysed by the NRZ. In order to submit national data to the ECDC, a representative sample of 46 hospitals was generated, although other hospitals were invited to participate in the survey if interested. Results: In total, 41539 patients were surveyed in 132 hospitals. AU prevalence in these hospitals and in the representative sample did not differ significantly [25.5% (95% CI 24.5% - 26.6%) and 23.3% (95% CI 21.3% - 25.5%), respectively]. AU rates were higher compared with a previous survey in 1994. Antimicrobials were administered for treatment in 70% and prophylaxis in 30% of cases. Surgical prophylaxis (SP) was prolonged (>1 day) in 70% of cases. Indication was documented in patients' charts in 73% of administrations. The most frequently used agents were cefuroxime (14.3%), ciprofloxacin (9.8%) and ceftriaxone (7.5%). Conclusions: The study identified several points for improvement, e.g. the large amount of prolonged SP, the extensive use of broad-spectrum antibiotics and the high percentage of antibiotic administration without documented indication.