Jonathan Cooke1, Peter Stephens2, Diane Ashiru-Oredope3, Esmita Charani4, Mathew Dryden5, Carole Fry6, Kieran Hand7, Alison Holmes4, Philip Howard8, Alan P Johnson9, David M Livermore10, Paula Mansell11, Cliodna A M McNulty12, Sally Wellsteed6, Susan Hopkins13, Mike Sharland14. 1. The Centre for Infection Prevention and Management, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W12 0NN, UK Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK j.cooke@imperial.ac.uk. 2. IMS Health, 210 Pentonville Road, London, UK. 3. Healthcare-Associated Infection, Antimicrobial Resistance and Stewardship and Healthcare-Associated Infections Programme, Public Health England, London, UK. 4. The Centre for Infection Prevention and Management, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W12 0NN, UK. 5. Royal Hampshire County Hospital, Winchester, UK. 6. Infectious Diseases and Blood Policy Branch, Department of Health, London, UK. 7. Faculty of Health Sciences, University of Southampton, Southampton, UK. 8. Leeds Teaching Hospitals NHS Trust, Leeds, UK. 9. Department of Healthcare-Associated Infections and Antimicrobial Resistance, Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK. 10. Antimicrobial Resistance and Healthcare-Associated Infections Reference Unit, Public Health England, London, UK Norwich Medical School, University of East Anglia, Norwich, UK. 11. The Care Quality Commission, London, UK. 12. Public Health England Primary Care Unit, Microbiology Department, Gloucester Royal Hospital, Gloucester, UK. 13. Healthcare-Associated Infection, Antimicrobial Resistance and Stewardship and Healthcare-Associated Infections Programme, Public Health England, London, UK Royal Free London NHS Foundation Trust, London, UK. 14. Paediatric Infectious Diseases Unit, St George's Hospital, London, UK.
Abstract
OBJECTIVES: There is global concern that antimicrobial resistance is a major threat to healthcare. Antimicrobial use is a primary driver of resistance but little information exists about the variation in antimicrobial use in individual hospitals in England over time or comparative use between hospitals. The objective of this study was to collate, analyse and report issue data from pharmacy records of 158 National Health Service (NHS) acute hospitals. METHODS: This was a cohort study of inpatient antibacterial use in acute hospitals in England analysed over 5 years through a data warehouse from IMS Health, a leading provider of information, services and technology for the healthcare industry. Around 98% of NHS hospitals were included in a country with a population of 50 million residents. RESULTS: There was a dramatic change in the usage of different groups of antibacterials between 2009 and 2013 with a marked reduction in the use of first-generation cephalosporins by 24.7% and second-generation cephalosporins by 41%, but little change in the use of third-generation cephalosporins (+5.7%) and fluoroquinolones (+1.6%). In contrast, use of co-amoxiclav, carbapenems and piperacillin/tazobactam increased by 60.1%, 61.4% and 94.8%, respectively. There was wide variation in the total and relative amounts of antibacterials used between individual hospitals. CONCLUSIONS: Longitudinal analysis of antibacterial use demonstrated remarkable changes in NHS hospitals, probably reflecting governmental and professional guidance to mitigate the risk of Clostridium difficile infection. The wide variation in usage between individual hospitals suggests potential for quality improvement and benchmarking. Quality measures of optimal hospital antimicrobial prescribing need urgent development and validation to support antimicrobial stewardship initiatives.
OBJECTIVES: There is global concern that antimicrobial resistance is a major threat to healthcare. Antimicrobial use is a primary driver of resistance but little information exists about the variation in antimicrobial use in individual hospitals in England over time or comparative use between hospitals. The objective of this study was to collate, analyse and report issue data from pharmacy records of 158 National Health Service (NHS) acute hospitals. METHODS: This was a cohort study of inpatient antibacterial use in acute hospitals in England analysed over 5 years through a data warehouse from IMS Health, a leading provider of information, services and technology for the healthcare industry. Around 98% of NHS hospitals were included in a country with a population of 50 million residents. RESULTS: There was a dramatic change in the usage of different groups of antibacterials between 2009 and 2013 with a marked reduction in the use of first-generation cephalosporins by 24.7% and second-generation cephalosporins by 41%, but little change in the use of third-generation cephalosporins (+5.7%) and fluoroquinolones (+1.6%). In contrast, use of co-amoxiclav, carbapenems and piperacillin/tazobactam increased by 60.1%, 61.4% and 94.8%, respectively. There was wide variation in the total and relative amounts of antibacterials used between individual hospitals. CONCLUSIONS: Longitudinal analysis of antibacterial use demonstrated remarkable changes in NHS hospitals, probably reflecting governmental and professional guidance to mitigate the risk of Clostridium difficile infection. The wide variation in usage between individual hospitals suggests potential for quality improvement and benchmarking. Quality measures of optimal hospital antimicrobial prescribing need urgent development and validation to support antimicrobial stewardship initiatives.