Global increase and geographic convergence in antibiotic consumption between 2000 and 2015

Tracking antibiotic consumption patterns over time and across countries could inform policies to optimize antibiotic prescribing and minimize antibiotic resistance, such as setting and enforcing per capita consumption targets or aiding investments in alternatives to antibiotics. In this study, we analyzed the trends and drivers of antibiotic consumption from 2000 to 2015 in 76 countries and projected total global antibiotic consumption through 2030. Between 2000 and 2015, antibiotic consumption, expressed in defined daily doses (DDD), increased 65% (21.1–34.8 billion DDDs), and the antibiotic consumption rate increased 39% (11.3–15.7 DDDs per 1,000 inhabitants per day). The increase was driven by low- and middle-income countries (LMICs), where rising consumption was correlated with gross domestic product per capita (GDPPC) growth (P = 0.004). In high-income countries (HICs), although overall consumption increased modestly, DDDs per 1,000 inhabitants per day fell 4%, and there was no correlation with GDPPC. Of particular concern was the rapid increase in the use of last-resort compounds, both in HICs and LMICs, such as glycylcyclines, oxazolidinones, carbapenems, and polymyxins. Projections of global antibiotic consumption in 2030, assuming no policy changes, were up to 200% higher than the 42 billion DDDs estimated in 2015. Although antibiotic consumption rates in most LMICs remain lower than in HICs despite higher bacterial disease burden, consumption in LMICs is rapidly converging to rates similar to HICs. Reducing global consumption is critical for reducing the threat of antibiotic resistance, but reduction efforts must balance access limitations in LMICs and take account of local and global resistance patterns.

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Evaluating the Relationship Between Hospital Antibiotic Use and Antibiotic Resistance in Common Nosocomial Pathogens

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2017.222 ◽

2017 ◽

Vol 38 (12) ◽

pp. 1457-1463 ◽

Cited By ~ 14

Author(s):

Annie Wang ◽

Nick Daneman ◽

Charlie Tan ◽

John S. Brownstein ◽

Derek R. MacFadden

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Susceptibility ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Hospital Type ◽

Defined Daily Doses ◽

Resistance Patterns ◽

Antibiotic Resistance Patterns ◽

The Relationship ◽

Resistance Data

OBJECTIVEThe relationship between hospital antibiotic use and antibiotic resistance is poorly understood. We evaluated the association between antibiotic utilization and resistance in academic and community hospitals in Ontario, Canada.METHODSWe conducted a multicenter observational ecological study of 37 hospitals in 2014. Hospital antibiotic purchasing data were used as an indicator of antibiotic use, whereas antibiotic resistance data were extracted from hospital indexes of resistance. Multivariate regression was performed, with antibiotic susceptibility as the primary outcome, antibiotic consumption as the main predictor, and additional covariates of interest (ie, hospital type, laboratory standards, and patient days).RESULTSWith resistance data representing more than 90,000 isolates, we found the increased antibiotic consumption in defined daily doses per 1,000 patient days (DDDs/1,000 PD) was associated with decreased antibiotic susceptibility forPseudomonas aeruginosa(−0.162% per DDD/1,000 PD;P=.119). However, increased antibiotic consumption predicted increased antibiotic susceptibility significantly forEscherichia coli(0.173% per DDD/1,000 PD;P=.005),Klebsiellaspp (0.124% per DDD/1,000 PD;P=.004),Enterobacterspp (0.194% per DDD/1,000 PD;P=.003), andEnterococcusspp (0.309% per DDD/1,000 PD;P=.001), and nonsignificantly forStaphylococcus aureus(0.012% per DDD/1,000 PD;P=.878). Hospital type (P=.797) and laboratory standard (P=.394) did not significantly predict antibiotic susceptibility, while increased hospital patient days generally predicted increased organism susceptibility (0.728% per 10,000 PD;P<.001).CONCLUSIONSWe found that hospital-specific antibiotic usage was generally associated with increased, rather than decreased hospital antibiotic susceptibility. These findings may be explained by community origins for many hospital-diagnosed infections and practitioners choosing agents based on local antibiotic resistance patterns.Infect Control Hosp Epidemiol2017;38:1457–1463

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Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

Eurosurveillance ◽

10.2807/1560-7917.es.2016.21.32.30312 ◽

2016 ◽

Vol 21 (32) ◽

Cited By ~ 1

Author(s):

Ajay Oza ◽

Fionnuala Donohue ◽

Howard Johnson ◽

Robert Cunney

Keyword(s):

Administrative Data ◽

Risk Adjustment ◽

Antibiotic Consumption ◽

Factors Affecting ◽

Defined Daily Doses ◽

Acute Hospitals ◽

Consumption Rates ◽

Hospital Antibiotic Consumption ◽

Bed Days ◽

The Impact

As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed.

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Evaluation of antibiotic usage in swine reproduction farms in Umbria region based on the quantitative analysis of antimicrobial consumption

Italian Journal of Food Safety ◽

10.4081/ijfs.2017.6886 ◽

2017 ◽

Vol 6 (3) ◽

Cited By ~ 2

Author(s):

Fausto Scoppetta ◽

Marco Sensi ◽

Maria Pia Franciosini ◽

Marinella Capuccella

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Diagnostic Methods ◽

Antibiotic Administration ◽

Oral Antibiotic ◽

Defined Daily Doses ◽

Umbria Region ◽

Antimicrobial Susceptibility Tests ◽

Critical Aspects

Antibiotic use in food-producing animals has considerable impact on public health, especially with respect to the development and spread of antibiotic resistance. Pigs represent one of the main species in which antibiotics are frequently used for different purposes. Surveillance of antibiotic consumption and dose appropriateness, through novel approaches based on defined daily doses, is strongly needed to assess farms’ antibiotic risk, in terms of spread of antibiotic resistance and possibile presence of residues in meat. In this study, antibiotic consumption was monitored in 14 swine reproduction farms, together with managerial, structural, and health aspects. Most of the controlled farms (65%) were classified as at medium antibiotic risk, 21% at high antibiotic risk, and 14% at low antibiotic risk. Critical aspects of antibiotic administration concerned treatments for suckling and weaner piglets, oral antibiotic administration, treatment and diagnosis of gastroenteric infections, and use of critically important antimicrobials for human medicine, especially colistin. These aspects could be considered critical aspects of antibiotic use in from-farrow-to-wean/finish swine farms in the Umbria region and must be controlled to minimize risks. Even though a small number of farms in Umbria region are at high antibiotic risk, the risk of antibiotic resistance should be minimized, and management and biosecurity of the farms should be improved by extending the use of antimicrobial susceptibility tests and optimizing the diagnostic methods for infectious diseases. Furthermore, farmers’ and veterinarians’ knowledge of antibiotic resistance should be improved and the prudent use of antibiotics encouraged to prevent the development and spread of resistant microorganisms.

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Antibiotic-prescribing and antibiotic-resistance patterns among elderly citizens residing in two Nordic regions

Infectious Diseases ◽

10.1080/23744235.2019.1711159 ◽

2020 ◽

Vol 52 (4) ◽

pp. 257-265

Author(s):

Matilde Bøgelund Hansen ◽

Magnus Arpi ◽

Katarina Hedin ◽

Eva Melander ◽

Frederik Boëtius Hertz ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Prescribing ◽

Resistance Patterns ◽

Antibiotic Resistance Patterns

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Antibiotic resistance patterns of Escherichia coli urinary isolates and comparison with antibiotic consumption data over 10 years, 2005–2014

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-016-1538-z ◽

2017 ◽

Vol 186 (3) ◽

pp. 733-741 ◽

Cited By ~ 16

Author(s):

P. J. Stapleton ◽

D. J. Lundon ◽

R. McWade ◽

N. Scanlon ◽

M. M. Hannan ◽

...

Keyword(s):

Escherichia Coli ◽

Antibiotic Resistance ◽

Antibiotic Consumption ◽

Consumption Data ◽

Resistance Patterns ◽

Antibiotic Resistance Patterns ◽

Urinary Isolates

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Impact of pediatric influenza vaccination on antibiotic resistance in England and Wales

10.1101/19003657 ◽

2019 ◽

Author(s):

Chungman Chae ◽

Nicholas G. Davies ◽

Mark Jit ◽

Katherine E. Atkins

Keyword(s):

Antibiotic Resistance ◽

Influenza Vaccination ◽

Bacterial Infections ◽

Viral Infections ◽

Antibiotic Consumption ◽

Data Sources ◽

Published Data ◽

Antibiotic Prescribing ◽

England And Wales ◽

Health Burdens

Vaccines against viral infections have been proposed to reduce antibiotic prescribing and thereby help control resistant bacterial infections. However, by combining published data sources, we predict that pediatric live attenuated influenza vaccination in England and Wales will not have a major impact upon antibiotic consumption or health burdens of resistance.

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Surveillance of Antibiotic Prescribing in Intensive Care Units in Poland

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2018/5670238 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Ewa Trejnowska ◽

Aleksander Deptuła ◽

Magda Tarczyńska-Słomian ◽

Piotr Knapik ◽

Miłosz Jankowski ◽

...

Keyword(s):

Health Care ◽

Intensive Care ◽

Intensive Care Units ◽

Antibiotic Treatment ◽

Antibiotic Consumption ◽

Public Health Care ◽

Antibiotic Prescribing ◽

Icu Stay ◽

Defined Daily Doses ◽

Length Of Icu Stay

Antibiotic use and microbial resistance in health care-associated infections are increasing globally and causing health care problems. Intensive Care Units (ICUs) represent the heaviest antibiotic burden within hospitals, and sepsis is the second noncardiac cause of mortality in ICUs. Optimizing appropriate antibiotic treatment in the management of the critically ill in ICUs became a major challenge for intensivists. We performed a surveillance study on the antibiotic consumption in 108 Polish ICUs. We determined which classes of antibiotics were most commonly consumed and whether they affected the length of ICU stay and the size and category of the hospital. A total of 292.389 defined daily doses (DDD) and 192.167 patient-days (pd) were identified. Antibiotic consumption ranged from 620 to 3960 DDD/1000 pd. The main antibiotic classes accounted for 59.6% of the total antibiotic consumption and included carbapenems (17.8%), quinolones (14%), cephalosporins (13.7%), penicillins (11.9%), and macrolides (2.2%), respectively, whereas the other antibiotic classes accounted for the remainder (40.4%) and included antifungals (34%), imidazoles (20%), aminoglycosides (18%), glycopeptides (15%), and polymyxins (6%). The most consumed antibiotic classes in Polish ICUs were carbapenems, quinolones, and cephalosporins, respectively. There was no correlation between antibiotic consumption in DDD/1000 patient-days, mean length of ICU stay, size of the hospital, size of the ICU, or the total amount of patient-days. It is crucial that surveillance systems are in place to guide empiric antibiotic treatment and to estimate the burden of resistance. Appropriate use of antibiotics in the ICU should be an important public health care issue.

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Impact of Social, Economic, and Healthcare Factors on the Regional Structure of Antibiotic Consumption in Primary Care in Poland (2013–2017)

Frontiers in Public Health ◽

10.3389/fpubh.2021.680975 ◽

2021 ◽

Vol 9 ◽

Author(s):

Anna Olczak-Pieńkowska ◽

Waleria Hryniewicz

Keyword(s):

Risk Factors ◽

Primary Care ◽

Antibiotic Resistance ◽

Reproductive Activity ◽

Antibiotic Consumption ◽

Population Mobility ◽

Statistical Parameters ◽

Healthcare Data ◽

Defined Daily Doses ◽

Central Statistical

Antibiotic resistance is one of the most important public health threats worldwide. Antimicrobial misuse and overuse are well-recognized risk factors for the resistance emergence and spread. Monitoring of antibiotic consumption (AC) is an important element in strategies to combat antibiotic resistance. As a result of AC surveillance in Poland, regional differences in AC levels were observed. This study aimed to characterize the regional AC in the period 2013–2017 in primary care in Poland and to assess the possible determinants that influence the AC at the regional level. The study analyzed relationships between AC and its factors (grouped in three different categories: demographic, economic, and related to the organization of healthcare). Data covered AC in primary care in 5 years period (2013–2017) from all 16 Polish voivodeships. The AC primary care data were sales data, expressed in defined daily doses (DDD) according to the WHO methodology. The yearly data on demographic, economic, and related healthcare factors were downloaded from the Central Statistical Office of Poland. Standard statistical parameters were used to characterize the AC. Non-standardized regression coefficients were used to estimate the quantitative dependence of variables. The strongest correlation was demonstrated with factors related to employment, female reproductive activity, mobility of the population, the number of outpatient consultations, and the number of dentists. A correlation was also found between population mobility and density. Recognized risk factors for increased AC should be a priority for interventions implementing and disseminating rational antibiotic policy.

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Antibiotic Prescribing to Patients with Infectious and Non-Infectious Indications Admitted to Obstetrics and Gynaecology Departments in Two Tertiary Care Hospitals in Central India

Antibiotics ◽

10.3390/antibiotics9080464 ◽

2020 ◽

Vol 9 (8) ◽

pp. 464

Author(s):

Anna Machowska ◽

Kristoffer Landstedt ◽

Cecilia Stålsby Lundborg ◽

Megha Sharma

Keyword(s):

Broad Spectrum ◽

Anatomical Therapeutic Chemical ◽

Tertiary Care ◽

Central India ◽

Fixed Dose ◽

Antibiotic Prescribing ◽

Middle Income ◽

Obstetrics And Gynaecology ◽

Defined Daily Doses ◽

Tertiary Care Hospitals

Background: Patients admitted to obstetrics and gynaecology (OBGY) departments are at high risk of infections and subsequent antibiotic prescribing, which may contribute to antibiotic resistance (ABR). Although antibiotic surveillance is one of the cornerstones to combat ABR, it is rarely performed in low- and middle-income countries. Aim: To describe and compare antibiotic prescription patterns among the inpatients in OBGY departments of two tertiary care hospitals, one teaching (TH) and one nonteaching (NTH), in Central India. Methods: Data on patients’ demographics, diagnoses and prescribed antibiotics were collected prospectively for three years. Patients were divided into two categories- infectious and non-infectious diagnosis and were further divided into three groups: surgical, nonsurgical and possible-surgical indications. The data was coded based on the Anatomical Therapeutic Chemical classification system, and the International Classification of Disease system version-10 and Defined Daily Doses (DDDs) were calculated per 1000 patients. Results: In total, 5558 patients were included in the study, of those, 81% in the TH and 85% in the NTH received antibiotics (p < 0.001). Antibiotics were prescribed frequently to the inpatients in the nonsurgical group without any documented bacterial infection (TH-71%; NTH-75%). Prescribing of broad-spectrum, fixed-dose combinations (FDCs) of antibiotics was more common in both categories in the NTH than in the TH. Overall, higher DDD/1000 patients were prescribed in the TH in both categories. Conclusions: Antibiotics were frequently prescribed to the patients with no documented infectious indications. Misprescribing of the broad-spectrum FDCs of antibiotics and unindicated prescribing of antibiotics point towards threat of ABR and needs urgent action. Antibiotics prescribed to the inpatients having nonbacterial infection indications is another point of concern that requires action. Investigation of underlying reasons for prescribing antibiotics for unindicated diagnoses and the development and implementation of antibiotic stewardship programs are recommended measures to improve antibiotic prescribing practice.

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