A 3 year survey on the use of antibacterial agents in five Italian hospitals

Background: Misuse of antimicrobial agents in hospitals may cause the emergence of resistant microorganisms, as well as increased costs and unnecessary exposure of patients to drugs. We investigated the pattern of antibiotic consumption in 2002-04 in a sample of Italian hospitals, and compared this with antibiotic consumption data in primary healthcare in the Emilia-Romagna region. Methods: The study was carried out in five hospitals of the Emilia-Romagna region and 2002-04 drug use data were obtained from the pharmacy services. Data were analysed by clinical areas and single wards and were expressed by ATC classification and defined daily doses (DDD)/100 bed days. Prescription data of antibacterials in primary care in the same period were also analysed. Results: Antibiotic consumption increased by 18% in the 3 year period. Combinations of penicillins and beta-lactamase inhibitors were the most used drugs, followed by fluoroquinolones and third-generation cephalosporins. Penicillins plus beta-lactamase inhibitors increased in all the clinical areas by over 40%, and fluoroquinolones sharply increased in medical units (+29%). Third-generation cephalosporins remained fairly stable in paediatrics and surgery, but increased in medicine (+18%). Glycopeptides accounted for 4.3% of total antibiotic consumption with a peak of 10% in intensive care units. Antibacterial prescription in primary care showed a pattern similar to that of hospitals. Conclusions: We found a considerable increase in antibiotic use over time and a marked preference for wide-spectrum antibiotics such as penicillins plus beta-lactamase inhibitors, fluoroquinolones and third-generation cephalosporins; thus raising concern about appropriate use. These results could represent the basis for educational initiatives aimed at rationalizing the use of antibiotics in hospitals.