Abstract
Background:
Reports on antibiotic use often lack complete definitions of the units of measurement, hampering the comparison of data between hospitals or hospital units.
Patients and Methods:
To compare methods of measures of in-hospital antimicrobial use, we determined aggregate in-hospital consumption data at a tertiary care university hospital using variations of nominators and denominators. Means of defined daily doses (DDD) of individual antimicrobials per 100 bed-days and per 100 admissions at each hospital and intensive care unit (ICU) were calculated. Furthermore, a literature review was performed for benchmarking purposes.
Results:
Antibiotic use in different hospital units ranged from 0.105 to 323.37 DDD/100 bed-days and from 4.23 to 6737.92 DDD/100 admissions, respectively. Including the day of discharge in the denominator ‘bed-days’ underestimated antibiotic use in various hospital wards by up to 27.7 DDD/100 bed-days (26.0%). Equating ‘numbers of patients admitted to the hospital’ and ‘numbers of admissions’ on a hospital level resulted in a difference of 192.6 DDD/100 admissions (64%) because patients transferred between hospital units accounted for multiple admissions. Likewise, reporting antimicrobial (Anatomical Therapeutic Chemical [ATC] group ‘J’) instead of antibiotic (ATC group ‘J01’) use led to a difference of 16.5 DDD/100 bed-days (19.3%). The literature review revealed underreporting of complete definitions of antibiotic use measurements.
Conclusions:
Data on in-hospital antimicrobial use vary widely not only due to different antibiotic policies at different institutions but also due to different methods of measures. Adherence to the standard of reporting the methods of measurement is warranted for benchmarking and promotion of rational antimicrobial use.
Similar content being viewed by others
References
Barbosa da Silva JJ, Siqueira JB Jr, Coelho GE, Vilarinhos PTR, Pimenta FG Jr: Dengue in Brazil, current situation and prevention and control activities. Epidemiol Bull 2002; 23: 3–6.
Siqueira JB, Martelli CMT, Maciel IJ, Oliveira RM, Ribeiro MG, Amorim FP, Moreira BC, Cardoso DDP, Souza WV, Andrade ALSS: Household survey of dengue infection in central Brazil: spatial point pattern analysis and risk factors assessment. Am J Trop Med Hyg 2004; 71: 646–651.
Teixeira MG, Barreto ML, Costa MC, Ferreira LD, Vasconcelos PF, Cairncross S: Dynamics of dengue virus circulation: a silent epidemic in a complex urban area. Trop Med Int Health 2002; 7: 757–762.
Vasconcelos PF, Lima JW, Rosa AP, Timbo MJ, Rosa ES, Lima HR, Rodrigues SG, Rosa JF: Dengue epidemic in Fortaleza, Ceara: randomized seroepidemiologic survey. Rev Saude Publica 1998; 32: 447–454.
Dietz VJ, Gubler DJ, Rigau-Perez JG, Pinheiro F, Schatzmayr HG, Bailey R, Gunn RA: Epidemic dengue 1 in Brazil, 1986: evaluation of a clinically based dengue surveillance system. Am J Epidemiol 1990; 131: 693–701.
Marzochi KBF: Endemic dengue: surveillance strategy challenges. Rev Soc Bras Med Trop 2004; 375: 413–415.
De Simone TS, Nogueira RM, Araujo ES, Guimarães FR, Santos FB, Souza RV, Teixeira-Filho G, Miagostovich MP: Dengue virus surveillance: theco-circulationof Den-1,Den-2andDen-3intheStateof Rio de Janeiro, Brazil. Trans R Soc TropMed Hyg 2004; 98: 553–562.
Nunes-Araújo FRF, Ferreira MS, Nishioka S de A: Dengue fever in Brazilian adults and children: assessment of clinical findings and their validity for diagnosis. Ann Trop Med Parasitol 2003;97: 415–419.
Martinez-Vega RA, Diaz-Quijano FA, Villar-Centeno LA: Low concordance between early clinical suspicion of dengue and its serological confirmation. Rev Med Chil 2006; 134: 1153–1160.
Diaz FA, Martinez RA, Villar LA: Clinical criteria to diagnose dengue in its early stages. Biomedica 2006; 26: 22–30.
Passos MNP, Santos LMG, Pereira MRR, Casali CG, Fortes BMD, Ortiz Valencia LI, Alexandre A de J, Medronho R de A: Clinical differences observed in patients with dengue caused by different serotypes in the epidemic of 2001/2002, occurred in Rio de Janeiro. Rev Soc Bras Med Trop 2004; 37: 293–295.
Casali CG, Pereira MRR, Santos LMG, Passos MNP, Fortes BMD, Ortiz Valencia LIO, Alexandre AJ, Medronho RA: The epidemic of dengue and hemorrhagic dengue fever in the city of Rio de Janeiro, 2001/2002. Rev Soc Bras Med Trop 2004; 37:296–299.
Martinez RA, Diaz FA, Villar LA: Evaluación de la definición Clínica de dengue sugerida por la Organización Mundial de la Salud. Biomédica 2004; 25: 412–416.
Phuong HL, de Vries PJ, Nga TTT, Giao PT, Hung LQ, Binh TQ, Nguyen VN, Nagelkerke N, Kager PA: Dengue as a cause of acute undifferentiated fever in Vietnam. BMC Infect Dis 2006; 6: 123.
Kuno G: Serodiagnosis of flavivirus infection and vaccination in humans. Adv Virus Res 2003; 61: 3–65.
Bandyopadhyay S, Lum LCS, Kroeger A: Classifying dengue: a review of the difficulties in using the WHO case classification for dengue haemorrhagic fever. Trop Med Int Health 2006; 11:1238–1255.
Brasil MS, Fundação Nacional de Saúde: Dengue. In: Guia de vigilância epidemiológica. FUNASA, Brasília 2002, pp 201–230.
WHO: Dengue haemorrahagic fever: diagnosis, treatment, prevention and control. (2nd edn.). World Health Organization, Geneva, 1997.
Nogueira RMR, Schatzmayr HG, de Filippis AMB, dos Santos FB, da Cunha RV, Coelho JO, de Souza LJ, Guimarães FR, de Araújo ESM, De Simone TS, Baran M, Teixeira G Jr, Miagostovich MP: Dengue virus type 3, Brazil, 2002. Emerg Infect Dis 2002; 11:1376–1381.
Gubler DJ, Kuno G, Sather GE, Valez M, Oliver A: Mosquito cell cultures and specific monoclonal antibodies in surveillance for dengue viruses. Am J Trop Med Hyg 1984; 33: 158–165.
Martinez-Torres E: Preventing deaths from dengue: a space and challenge for primary health care. Rev Panam Salud Publica 2006; 20: 60–74.
Low JG OEE, Tolfvenstam T, Leo YS, Hibberd ML, Ng LC, Lai YL, Yap GS, Li CS, Vasudevan SG, Ong A: Early dengue infection and outcome study (EDEN) - study design and preliminary findings. Ann Acad Med Singapore 2006; 35: 783–789.
Guzmán MG, Kouri G: Dengue, an update. Lancet Infect Dis 2002; 2: 33–42.
Hudson CP, Levett PN, Edwards CN, Moosai R, Roach TC: Severe primary HIV-1 infection among black persons in Barbados. Int J STD AIDS 1997; 8: 393–397.
Telles EE: Racial ambiguity among the Brazilian population. Ethn Racial Stud 2002; 25: 415–441.
Calisher CH, Karabatsos N, Dalrymple JM, Shope RE, Porterfield JS, Westaway EG, Brandt WE: Antigenic relationships between flaviviruses as determined by cross-neutralization tests with polyclonal antisera. J Gen Virol 1989; 70: 37–43.
Gubler DJ: Dengue and dengue hemorrhagic fever. Clin Microbiol Rev 1998; 11: 480–496.
Gibbons RV, Vaughn DW: Dengue: an escalating problem. BMJ 2002; 324: 1563–1566.
Travassos C, Williams DR: The concept and measurement of race and their relationship to public health: a review focused on Brazil and the United States. Cad Saude Publica 2004; 20: 660–678.
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, Vet HC: Standards for reporting of diagnostic accuracy. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ 2003; 326: 41–44.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kuster, S.P., Ruef, C., Ledergerber, B. et al. Quantitative Antibiotic Use in Hospitals: Comparison of Measurements, Literature Review, and Recommendations for a Standard of Reporting. Infection 36, 549–559 (2008). https://doi.org/10.1007/s15010-008-7462-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-008-7462-z