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. 2022 Oct;27(41):2101058.
doi: 10.2807/1560-7917.ES.2022.27.41.2101058.

Trends in the hospital-sector consumption of the WHO AWaRe Reserve group antibiotics in EU/EEA countries and the United Kingdom, 2010 to 2018

Ria Benkő  1   2   3 , Mária Matuz  1   2 , Zoltán Pető  3 , Klaus Weist  4 , Ole Heuer  4 , Vera Vlahović-Palčevski  5 , Dominique L Monnet  4 , Githa Fungie Galistiani  1 , Hege Salvesen Blix  6   7   8 , Gyöngyvér Soós  1 , Edit Hajdú  9 ; Members of the ESAC-Net AWaRe study group  10 ; ESAC-Net AWaRe study group
Collaborators, Affiliations

Trends in the hospital-sector consumption of the WHO AWaRe Reserve group antibiotics in EU/EEA countries and the United Kingdom, 2010 to 2018

Ria Benkő et al. Euro Surveill. 2022 Oct.

Abstract

BackgroundIn 2019, the World Health Organization published the 21st Model list of Essential Medicines and updated the Access, Watch Reserve (AWaRe) antibiotics classification to improve metrics and indicators for antibiotic stewardship activities. Reserve antibiotics are regarded as last-resort treatment options.AimWe investigated hospital-sector consumption quantities and trends of Reserve group antibiotics in European Union/European Economic Area countries and the United Kingdom (EU/EEA/UK).MethodsHospital-sector antimicrobial consumption data for 2010-2018 were obtained from the European Centre for Disease Prevention and Control. Antibacterials' consumption for systemic use (Anatomical Therapeutic Chemical classification (ATC) group J01) were included in the analysis and expressed as defined daily doses (DDD) per 1,000 inhabitants per day. We defined reserve antibiotics as per AWaRe classification and applied linear regression to analyse trends in consumption of reserve antibiotics throughout the study period.ResultsEU/EEA/UK average hospital-sector reserve-antibiotic consumption increased from 0.017 to 0.050 DDD per 1,000 inhabitants per day over the study period (p = 0.002). This significant increase concerned 15 countries. In 2018, four antibiotics (tigecycline, colistin, linezolid and daptomycin) constituted 91% of the consumption. Both absolute and relative (% of total hospital sector) consumption of reserve antibiotics varied considerably (up to 42-fold) between countries (from 0.004 to 0.155 DDD per 1,000 inhabitants per day and from 0.2% to 9.3%, respectively).ConclusionAn increasing trend in reserve antibiotic consumption was found in Europe. The substantial variation between countries may reflect the burden of infection with multidrug-resistant bacteria. Our results could guide national actions or optimisation of reserve antibiotic use.

Keywords: DDD per 1,000 inhabitants per day; Europe; antibacterial use; antibiotic stewardship; drug utilisation; hospital care sector; public health; reserve group.

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Conflict of interest statement

Conflict of interest: Ria Benko was supported by the János Bólyai research scholarship of the Hungarian Academy of Sciences. Other authors declare no competing interests.

Figures

Figure 1
Figure 1
Hospital-sector consumption (in DDD per 1,000 inhabitants per day) of Reserve group antibioticsa, as well as changes in consumption over the study period, EU/EEA countries and the UK, 2010–2018 (n = 23 countries)
Figure 2
Figure 2
Countries according to proportions of Reserve groupa antibiotics among antibacterials consumed for systemic useb in the hospital sector, EU/EEA countries and the UK, 2018 (n = 23 countries)
Figure 3
Figure 3
Yearly proportions of Reserve groupa antibiotics among antibacterials consumed for systemic useb in the hospital sector, as well as changes over the study period, EU/EEA and the UK, 2010–2018 (n = 23 countries)
Figure 4
Figure 4
Hospital-sector consumption (in DDD per 1,000 inhabitants per day) of Reserve group antibioticsa, EU/EEA countries and the UK, 2018 (n = 23 countries)
See this image and copyright information in PMC

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