v v v v

Antibiotic consumption in hospitals:

hospital sector definition in France

Acute care hospitals and others…

February 2015

Surveillance ATB-RAISIN in France

• Objectives

To describe antibiotic consumption in French HCF at

hospital and at ward level • tool for benchmarking

• analysis of consumption data against antimicrobial resistance rates

• improvement at the hospital level and at the national level

To monitor trends

Hospital sector in France ?

Different kind of HCF

• Hospitals, public or private, with inpatients +/- outpatients

• Home-care hospitals (HAD) Part of conventional hospitals

• Dialysis centers

• Others…

Type N

CHUniversity 81

CH % acute care beds from 0 to100% 570

MCO 669

CLCC 20

HIA 9

ESSR 738

LOC now CH 255

ESLD 46

PSY 247

Total 2 636

• LTCF are not nursing homes

LTCF providing « little » medical care became

« nursing homes »

Data collection in the hospital

sector

• ESAC-Net

Hospital sector as a whole (100%): sales data from ANSM

• ATB-Raisin

Hospital-based

Voluntarily

participation (1488 in

2013)

Data collection in the hospital sector

• Scope of surveillance : All HCF with inpatients

HCF performing acute care

• Teaching or not, public or private

May include non acute care wards

• Specialised in cancer treatment

AND HCF performing non acute care

• rehabilitation centres, long term-care HCF (not NH), psychiatric centres

Data collection in the hospital sector

• In the participating HCF: Inpatients only

• Outpatient, day-care, dialysis excluded

• Detailed by ward/clinical activity (76% of HCF)

Acute care = Medicine, Surgery, ICU, gyneacology, and

paediatrics

Non acute care = rehabilitation, long-term care & psychiatry

Data collection in the hospital sector

• Rationale for scope of surveillance

• All HCF: information on prudent antibiotic use First step before tailored activity to ensure prudent use of AB

• Inpatients only: in accordance to denominator

Outpatients wards: not all HCF

ATB-Raisin participants

Type N n %

CHU 81 40 49

CH 570 393 69

MCO 669 423 63

CLCC 20 13 65

HIA 10 8 80

ESSR 738 342 46

LOC 255 125 49

ESLD 46 18 39

PSY 247 126 51

Total 2 636 1 488 56

ATB-Raisin participants

Type n No. PD %

CHU 40 11 513 046 14%

CH 393 35 722 232 43%

MCO 423 13 594 617 16%

CLCC 13 436 422 1%

HIA 8 465 618 1%

ESSR 342 10 154 373 12%

LOC 125 2 099 228 3%

ESLD 18 417 964 1%

PSY 126 8 305 309 10%

Total 1 488 82 708 809 100%

Data collection in the hospital sector

• Antibiotics for systemic use Dispensed by the pharmacy for inpatients only NB: no dispensing for discharged patients in France

• Administrative data Denominator consistent with scope of surveillance

• number of patients-days (PD) for inpatients only

“Journée d’hospitalisation” for stay > 24 h

(different from « one-day stay » < 24h)

• number of “direct” admissions (acute care only) Only one admission for one patient admitted for at least 24 h, even if transferred from

ICU to medicine

• Administrative definitions for “Journée d’hospitalisation” and “direct admission”

Data presentation

• Antibiotic consumption:

global use (pooled or weighted mean)

and distribution in no. DDD/ 1000 PD (and /100 AD for acute care wards)

According to HCF type

According to ward/clinical activity • (very) detailed tables

2008 2009 2010 2011

No. participating hospitals 861 997 1115 1262

Coverage (/ No. PD at national level) 44% 51% 52% 60%

Coverage (/ No. beds at national level) 42% 50% 52% 60%

Total antibiotic use (No. DDD/1000 PD) 369 379 374 372

020

040

060

080

010

0012

00

Teachinghospital

N=40

Nonteaching

publichospital<=33

N=73

Nonteaching

publichospital>33

N=320

NonteachingprivatehospitalN=423

Cancerhospital

N=13

Militaryhospital

N=8

Rehabcentre

N=342

Localhospital

N=125

Longtermcare

N=18

Psychiatrichospital

N=126

Num

ber

of D

DD

/ 10

00 P

D

Data presentation: ATB RAISIN, 2013

• Total antibiotic use in 1 488 HCF: 377 DDD/1000 PD

Variations in total antibiotic use according to HCF type

Outlier

Highest value still within

P75+1,5(P75-P25)

P75

Pooled mean

Median

P25

Lowest value still within

P25-1,5(P75-P25)

02

00

40

06

00

80

01

00

01

20

0

>66%N=597

]33-66%]N=222

]0-33%]N=148

0%N=521

% of acute care beds

Nu

mb

er

of

DD

D /

10

00

PD

Data presentation: ATB RAISIN, 2013

• Total antibiotic use in 1 488 HCF

Variations in antibiotic use / % acute care beds

Outlier

Highest value still within

P75+1,5(P75-P25)

P75

Pooled mean

Median

P25

Lowest value still within

P25-1,5(P75-P25)

010

0020

0030

00

Medicine

N=560

Hematology

N=25

Infectious

diseases

N=13

Surgery

N=447

Intensive

care

N=178

Gynae-

cology

N=296

Paediatrics

N=205

Rehabi-

litation

N=758

Long

term care

N=304

Psychiatry

N=211

Num

ber

of D

DD

/ 10

00 P

DData presentation: ATB RAISIN, 2013

Variations in total antibiotic use according to ward/clinical activity

Esac-Net hospital based survey

Objectives

• Comparisons of patterns, quantity between hospitals from

different countries

Relevant settings for comparisons

• acute care wards, ICUs?

• Including paediatrics?

• Inpatients only?

Challenges: exclusion of non acute care wards, of

outpatients…

More information on antibiotic use in French hospitals

http://www.invs.sante.fr/raisin

http://www.cclin-arlin.fr/