Antibiotic Consumption 2017-2022 in 30 Private Hospitals in France: Impact of Antimicrobial Stewardship Tools and COVID-19 Pandemic

Abstract

Our aim was to determine the impact of antimicrobial stewardship tools (ASTs) and the COVID-19 pandemic on antibiotic consumption (AC). We used the national software Consores^® to determine AC in DDD/1000 days of hospitalization from 2017 to 2022 in voluntary private hospitals in France. The ASTs considered were: 1. internal guidelines; 2. the list of antibiotics with restricted access; 3. the presence of an antibiotic referent or 4. an ID specialist; and 5. proof of an annual meeting on antimicrobial resistance. Institutions with dedicated units for COVID-19 patients were specified. In 30 institutions, the total AC varied from (means) 390 to 405 DDD/1000 DH from 2017 to 2022. Fluoroquinolones and amoxicillin/clavulanate consumption decreased from 50 to 36 (p = 0.003) and from 112 to 77 (p = 0.025), respectively, but consumption of piperacillin/tazobactam increased from 9 to 21 (p < 0.001). Over the study period, 10 institutions with ≤2 AST had lower AC compared to 20 institutions with ≥3 AST (p < 0.01). COVID-19 units opened in 10 institutions were associated with a trend toward higher macrolide consumption from 15 to 25 from 2017 to 2020 (p = 0.065) and with an acceleration of piperacillin/tazobactam consumption from 2020 to 2022 (p ≤ 0.003). Antibiotic consumption in 30 private hospitals in France was inversely related to the number of AST. The COVID-19 pandemic was associated with limited impact on AC, but special attention should be paid to piperacillin/tazobactam consumption.

Keywords: COVID-19; antibiotic consumption; antimicrobial stewardship; defined daily doses; tools.

Figure 1

Antibiotic consumption (AC) from 30 institutions from 2017 to 2022. As the reports from Consores^® contain comparisons from previous year, data on AC in 2016 were available for 12 institutions. (A) Total AC was stable from 2017 to 2022 and significantly higher in institutions with ≥3 antimicrobial stewardship tools (n = 20, 67%). (B–D) In the same period, third-generation cephalosporins (cefotaxime, ceftriaxone, ceftazidime) consumption increased, while that of fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin) and amoxicillin/clavulanate decreased. Institutions with ≥3 AMS tools always had significantly higher AC compared to hospitals with ≤2 AMS tools.

Figure 2

Antibiotic consumption (AC) and main characteristics of the participating institutions. (A) Medical and/or surgical activities; (B) number of beds in 3 groups; (C) presence of an Intensive Care Unit; (D) presence of an infection disease (ID) specialist; (E) presence of an antibiotic referent; (F) internal guidelines; (G) list of antibiotics with restricted access; (H) annual meeting on antimicrobial resistance and antibiotic consumption between AMS team and physicians. Only significant differences are indicated. *: p < 0.050; **: p < 0.010.

Figure 3

Impact of the COVID-19 pandemic on antimicrobial consumption. Dedicated wards for COVID-19 patients were opened in ten institutions. The consumption of most antibiotics used for respiratory infections is shown. (A) amoxicillin/clavulanate; (B) ceftriaxone; (C) piperacillin/tazobactam; (D) macrolides (including erythromycin; azithromycin; spiramycin; roxithromycin).