Use of antibiotics in Italian hospitals: a 2004 to 2011 drug utilization survey.

Objectives: To assess antibiotic use in all the hospitals of Emilia-Romagna Region (ERR) through an analysis of both hospital antibiotic consumption and expenditure from 2004 to 2011. Methods: This study concerned 17 hospitals of the ERR. The analysis was based on the pharmacy records of each hospital collected by the ERR Health Authority Database. The number of bed-days was obtained from the regional hospital discharge database. Antibiotic drug consumption was expressed as DDDs per 100 bed-days used (BDU) and data were analyzed by active substances, by therapeutic subgroups and by single wards. Expenditure was expressed as Euros per 100 BDU. Results: In the 8-years considered, overall consumption increased by 27% and expenditure by 3%. Antibiotics use increased in almost all wards, but it grew sharply in the wards of the intensive care and pediatrics units according to a few European studies.[1,2] HIV infected patients, by themselves, do not justify the high antibiotic consumption recorded in infectious disease wards.[3] Penicillins and β-lactamase inhibitors ranked first representing 37% of total antibiotics used and 23% of expenditure in 2011, followed by fluoroquinolones and third-generation cephalosporins. A sharp increase was recorded for carbapenems (+90%) due to meropenem which increased by 202% in consumption and by 138% in expenditure, respectively. Conclusions: The inappropriate choice of antibiotics could be considered as one of the causes of the increased costs of therapy and of ecological consequences, such as the resistance development. Prudent antibiotic use and comprehensive infection control are the cornerstones of effective interventions aiming to prevent selection and transmission of antibiotic-resistant bacteria. Recognition of the most successful approaches by our institutions to ensure adherence to antibiotic use policies are needed.