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April 2014

Monitoring antibiotic consumption in hospitals: results from the French nationwide network “ ATB-RAISIN ” in 2012. April 2014. v. v. ATB - RAISIN. v. v. B. SCHLEMMER, AC. CREMIEUX, French Committee for prudent use of antibiotics S. ALFANDARI , French infectious disease society (SPILF)

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April 2014

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  1. Monitoring antibiotic consumption in hospitals: results from the French nationwide network “ATB-RAISIN” in 2012 April 2014 v v ATB - RAISIN v v

  2. B. SCHLEMMER, AC. CREMIEUX, French Committee for prudent use of antibiotics S. ALFANDARI , French infectious disease society (SPILF) X. BERTRAND, Microbiology, Besançon S. TOURATIER, Pharmacy, GH St Louis, Paris E. REMY, Regional observatory for medicines, Rouen v v ATB - RAISIN v v ATB-RAISIN Network: Surveillance of antibiotic consumption in hospitals • ATB-RAISIN steering committee • Other experts • 5 CCLIN* and InVS** • A. INGELS,P. JARNO CCLIN West  • S. BOUSSAT, L. MOUCHOT, CCLIN East • L. LACAVÉ, F. L’HÉRITEAU, CCLIN Paris & North  • M. GIARD, A. MACHUT, CCLIN S-East • C. DUMARTIN, M. PÉFAU, AM. ROGUES, CCLIN S-West  • S. VAUX, InVS * Coordinating centres for prevention and control of healthcare associated infections ** French Institute for Public Health Surveillance

  3. Background Antibiotic use national plan since 2001 HAI national programmes since 1994 Monitoring antibioticconsumption in Healthcarefacilities (HCF) • Guidelines : 1996, 2008 (National Authority for Health) • Ministerialcircular : 2006 « ATB-RAISIN » set up in 2009 Standardised methodology

  4. Objectives of ATB-RAISIN • To describe antibiotic consumption in French healthcare facilities (HCF) at hospital and at ward level • To provide a tool for benchmarking • To promote analysis of consumption data against antimicrobial resistance rates • To identify areas for improvement at the hospital level and at the national level • To describe antimycotic consumption at hospital level, in intensive care units (ICU) and hematology • To monitor trends

  5. Methods Retrospective survey Voluntarily participating HCF Self-completion questionnaire Antibiotics and antimycotics for systemic use Antibiotics: J01 AND Rifampicin + oral imidazole derivatives Antimycotics: J02 Dispensed by the pharmacy for inpatients wards only Number of defined daily doses (DDD) [WHO, ATC/DDD system] Administrative data HCF type, ward clinical activity, no. patient-days Antimicrobial resistance Selected antibiotic/bacteria combinations

  6. Results • Participation • 1411 HCF in 2012 • Coverage: 66% PD at national level Number of participating HCF

  7. Results: ATB RAISIN, 2012 Total antibiotic use in 1 411 HCF: 374 DDD/1000 PD Variations in total antibiotic use according to HCF type

  8. Results: ATB RAISIN, 2012 • Variations in total antibiotic use according to ward/clinical activity

  9. Results: ATB-RAISIN, 2012 • Most used antibiotics in 1 411 HCF, 2012 Top 5 67%

  10. 67% 64% 57% 100% 58% 60% 85% 68% 72% 94% 79% 84% 75% 62% 31% 84% 58% 44% 88% 81% 50% 80% 58% 23% 28% 100% Fait avec Philcarto - http://philcarto.free.fr Results: ATB-RAISIN, 2012 Consumption of antibiotics (J01+P01AB+J04) in number of DDD/1 000 PD (regional pooled mean), and surveillance coverage (% beds) (N= 1 409 HCF) 401.9 (P75) ≤ consumption < 515.0 (max) 356.5 (P50) ≤ consumption < 401.9 (P75) 331.8 (P25) ≤ consumption < 356.5 (P50) 165.2 (min) ≤ consumption < 331.8 (P25) Warning: data from voluntarily participating hospitals. Coverage is not homogenous among regions and the number of HCF may be small in some regions. Differences in patients case-mix may partially explain some of the variations in this map.

  11. 44% 31% 31% 34% 56% 39% 74% 63% 20% 93% 75% 58% 73% 58% 2% 70% 58% 25% 80% 81% 34% 30% 48% 34% 100% Fait avec Philcarto - http://philcarto.free.fr Results: ATB-RAISIN, 2012 Carbapenems consumption in number of DDD/1 000 PD (regional pooled mean), in acute care wards and surveillance coverage (% beds) (N= 630 HCF) 9.6 (P75) ≤ consumption < 16.5 (max) 7.1 (P50) ≤ consumption < 9.6 (P75) 3.3 (P25) ≤ consumption < 7.1 (P50) 0.4 (min) ≤ consumption < 3.3 (P25) Insufficient data Warning: data from voluntarily participating hospitals. Coverage is not homogenous among regions and the number of HCF may be small in some regions. Differences in patients case-mix may partially explain some of the variations in this map.

  12. Results: ATB-RAISIN, 2012 Proportion of antibiotics according to clinical wards

  13. Results: ATB-RAISIN, 2008-2012 • Trends in total antibiotic use, 2008 – 2012 (number of DDD/1000 PD), cohort of 565 hospitals • + 7.2% over the period… but trend toward stabilisation +0.6% +0.3% +2.5% +3.7%

  14. Trends in antibiotic use in no. DDD/1 000 PD (pooled mean) in 565 HCF that participated each year from 2008 to 2012 Results: ATB-RAISIN, 2008-2012

  15. Antibiotic use in number of DDD/1000 PD (pooled mean) in 565 hospitals, 2008-2012 (% change between 2008 and 2012) Results: ATB-RAISIN, 2008-2012

  16. Results: ATB-RAISIN, 2008-2012 • Contrasted changes in AMR Incidence of antimicrobial resistance in selected bacteria, in number of strains/1000 PD, in hospitals providing data each year from 2008 to 2012

  17. Results: ATB-RAISIN, 2012 Third generation cephalosporins (3GC) consumption and incidence of cefotaxime-resistant Enterobacter cloacae (N=334) Median = 36.8 DDD/ 1000 PD • Analysis: High AMR • Actions: • Infection control, admission screening • Prudent use of AB otherthan 3CG Resistantstrains/1000 PD Analysis: High AMR and AB Use Actions: Infection control to prevent spread Prudent use of AB Median = 0.18 / 1000 PD 3GC use in DDD/1000 PD

  18. Results: ATB-RAISIN, 2012Antimycotics consumption Antimycotics consumption (J02) according to clinical activity and for the whole HCF, in no. DDD/1000 PD

  19. Results: ATB-RAISIN, 2012Antimycotics consumption Pattern of antimycotic consumption (J02) in hematology and ICUs ICU (n=97) Hematology (n=26)

  20. Discussion • Participation in ATB-RAISIN increased • Antibiotic consumption did not decrease in HCF • Stabilisation of total use: good news in a context of decreasing length of stay • Decrease in FQ use • Actions needed to reduce the use of ceftriaxone

  21. Perspectives Mobilisation still needed! • Data used for action • At the local level • Analysis of consumption to foster implementation of actions such as practice audits, restricted dispensation • At regional and national levels • Awareness raised on antibiotic exposure: FQ, carbapenems, 3GC… • Tools for audits, educational material • Best use of data:quality indicator?

  22. Thanks to all healthcare professionals in participating hospitals More information on antibiotic use in French hospitals http://www.cclin-arlin.fr/ http://www.invs.sante.fr/raisin

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