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Factors Associated with the Prevalence of Antibiotic Use for the Treatment of Hospital-Acquired Infections at 393 French Hospitals: A Regional Variation Analysis

Published online by Cambridge University Press:  02 January 2015

B. Amadeo ,
C. Dumartin ,
A. G. Venier ,
A. Fourrier-Réglat ,
B. Coignard  and
A. M. Rogues
B. Amadeo*
Affiliation:
Institut National de la Santé et de la Recherche Médicale, Unité 657, Université de Bordeaux 2, Bordeaux, France
C. Dumartin
Affiliation:
Institut National de la Santé et de la Recherche Médicale, Unité 657, Université de Bordeaux 2, Bordeaux, France Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
A. G. Venier
Affiliation:
Institut National de la Santé et de la Recherche Médicale, Unité 657, Université de Bordeaux 2, Bordeaux, France Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
A. Fourrier-Réglat
Affiliation:
Institut National de la Santé et de la Recherche Médicale, Unité 657, Université de Bordeaux 2, Bordeaux, France Service de Pharmacologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
B. Coignard
Affiliation:
Institut de veille sanitaire, Paris, France
A. M. Rogues
Affiliation:
Institut National de la Santé et de la Recherche Médicale, Unité 657, Université de Bordeaux 2, Bordeaux, France Centre de Coordination de la Lutte contre les Infections Nosocomiales du Sud-Ouest, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
*
Service d'Hygiène Hospitalière, INSERM, Unité 657, Båt PQR Entrée 1, 1 Ère Étage, CHU Bordeaux, 33076 Bordeaux, France (brice.amadeo@chu-bordeaux.fr)
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Abstract

Objective.

The present study investigated regional variations in antibiotic use for the treatment of hospital-acquired infections (HAIs) in France by means of a multilevel analysis, to identify targets for quality improvement.

Methods.

Data were obtained from the 2001 and 2006 French national point-prevalence surveys of HAIs and antibiotic use. The present study was conducted using data from 393 nonteaching public hospitals. Data included patient characteristics calculated at the hospital level (mean age and proportion of patients with the following: HAI, presence of a vascular catheter, presence of a urinary catheter, surgical procedure, and immunodeficiency) and hospital characteristics (size and presence of an intensive care unit). The regional effect was measured using a random intercept on a regional variable.

Results.

Overall, the prevalence of antibiotic use was 5.35% for both study years. The most commonly used antibiotics for HAIs were fluoroquinolones (2001, 1.33%; 2006, 1.35%) and combinations of penicillins with a β-lactamase inhibitor (2001, 0.92%; 2006, 1.02%). Mapping of antibiotic use showed wide variation between regions. The regional effect explained 3% of antibiotic variation in the unadjusted analysis. In the multivariable analysis, hospital size, high prevalence of patients with immunodeficiency, and infection characteristics explained 45% of the variability in antibiotic use. The regional effect was not retained in the final model.

Conclusion.

The pattern of antibiotic use for HAIs differed over time, and regional variations were mostly explained by patient characteristics; there was no regional effect. Models that take data hierarchy into account are essential to better approach antibiotic use and develop relevant strategies for improvement.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 2 , February 2011 , pp. 155 - 162
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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