Consumption of antibiotics at St Luke’s Hospital : a critical factor behind the local prevalence of antimicrobial resistance?

Abstract

The intensity of antibiotic use in hospital settings is recognised as possibly the most important factor for the selection of antimicrobial resistance. Hospitals are therefore being encouraged to undertake surveillance and benchmarking of antimicrobial consumption patterns with a view to identify and rectify possible evidence of overuse or misuse. Use of antibiotics at St. Luke's Hospital, Malta (SLH) was assessed retrospectively for the year 2001 as part of participation in two pan-European antibiotic surveillance networks. Total antibiotic use during the study period averaged 147 Defined Daily Doses (DDD) /100 bed days with the three most common antibiotic groups prescribed being the penicillins, cephalosporins and macrolides. Combinations of penicillin with beta-lactamase inhibitor were the predominant antimicrobials in use and their consumption was twice the median for other participating hospitals in the European ARPAC network. Differences were additionally seen for second generation cephalosporins and macrolides, where consumption was also significantly higher at SLH. These findings would explain one possible factor behind the high prevalence of resistance, particularly in Staphylococcus aureus, at SLH and suggest the need to intensify efforts for improved antibiotic stewardship programmes in hospital prescribing.