vv v Worrying trends in antibiotic use in French, 2008-2013 C. Dumartin, A-M. Rogues, F. L Hériteau, M. Péfau, X. Bertrand, S. Boussat, H. Sénéchal, M. Giard, A. Ingels, L. Lacavé, L. Mouchot, A. Machut, S. Alfandari, R. Gauzit, P. Le Gonidec, B. Schlemmer, A.C. Crémieux, S. Touratier, S. Maugat, S. Vaux, for ATB-RAISIN network. Background HAI national programmes since 1994 Antibiotic use national plan since 2001 Antibiotic stewardship programmes in healthcare facilities (HCF) List of «high risk antibiotics» issued in Nov 2013 by the French National Agency for Medicines and Health Products Safety (ANSM ) Known to promote resistance Last-line agents 1
Objectives To analyse trends in antibiotic consumption in French HCF With a focus on high risk antibiotics Methods «ATB-RAISIN» surveillance network: retrospective survey, yearly data Paris Nancy Rennes Bordeaux Lyon Voluntarily participating HCF each year Cohort of 518 HCF Coverage: 20% HCF; 28% patient-days at national level 2
Methods Self-completion questionnaire Administrative data HCF type, number of patient-days (PD) Antibiotics for systemic use J01 AND Rifampicin + oral imidazole derivatives Dispensed by the pharmacy for inpatients only Number of defined daily doses (DDD) [WHO, ATC/DDD system] per 1000 PD Trend analysis: linear regression Results Nb DDJ / 1 000 JH Trends in total antibiotic use, 2008 2013, cohort of 518 +1.3% +1.0% +0.2% +0.4% +4.7% 400 393 393 395 389 384 380 367 360 340 320 + 7.8% 300 2008 2009 2010 2011 2012 2013 3
Results 700 600 Antibiotic use in 518, 2008-2013, according to hospital type +2.1% (% change between 2008 and 2013) 2008 2009 2010 2011 2012 2013 *significant trend 500 400 300 200 +11.5%* +5.8%* 0.0% -6.1%* +12.2% 100-8.4%* 0 Teaching (N=18) Public (N=167) Private acute care (N=152) Cancer centres (N=8) Rehabilitation centres (N=96) Local Long-term care (N=32) /psychiatric (N=45) Results β-lactam use in 518, 2008-2013 (% change between 2008 and 2013) 24 22 20 18 16 14 12 10 8 6 4 2 0 * +101.2% Piperacillin tazobactam J01CR05 +58.7% * Ceftriaxone J01DD04 Cefotaxime J01DD01 2008 2009 2010 2011 2012 2013 +3.2% +47.0% +1.5% Ceftazidime J01DD02 * Carbapenems J01DH 4
Results Anti-staphylococcal agents use in 518, 2008-2013 (% change between 2008 and 2013) 6 5 4 3 2 1 +14%* 2008 2009 2010 2011 2012 2013-19%* +154%* +4 392%* +31% 0 Vancomycin J01XA01 Teicoplanin J01XA02 Linezolid J01XX08 Daptomycin J01XX09 Results Fluoroquinolone use in 518, 2008-2013 (% change between 2008 and 2013) 22 20 18 16 14 12 10 8 6 4 2 0-8.2%* Ciprofloxacin J01MA02 2008 2009 2010 2011 2012 2013 +8.9% Levofloxacin J01MA12-15.5% * Ofloxacin J01MA01-14% 5
Discussion National survey to monitor antibiotic use in French since 2008 Diversity of facilities -> useful information on trends Variations according to hospital type Different patients and epidemiology Antibiotic stewardship programmes To considered for data analysis for local feedback and to better inform programmes Discussion No decrease in antibiotic use! Increase in some «high risk» antibiotics Similar trends in other European countries Epidemiology, activity, patient case-mix Prescribing practices and implementation of guidelines 6
Discussion Decrease in FQ use Ministerial and professional guidelines since 2006 Recent trend toward stabilisation of total use Good news in a context of decreasing length of stay? Perspectives Mobilisation still needed! New mandatory indicator on antibiotic stewardship programmes Emphasis on resources, active feedback and restrictive measures for high risk antibiotics Law to be voted: ability to restrict prescribing and dispensing of selected antibiotics for public health reasons 7
Thanks to all healthcare professionals in participating More information on antibiotic use in French http://www.cclin-arlin.fr/ http://www.invs.sante.fr/raisin @CclinSudOuest and @CclinSudEst Additional slides 8
ATB-RAISIN Network: Surveillance of antibiotic consumption in ATB-RAISIN steering committee vv v v 5 CCLIN* and InVS** Other experts A. INGELS, H. SENECHAL CCLIN West S. BOUSSAT, L. MOUCHOT, CCLIN East L. LACAVÉ, F. L HÉRITEAU, CCLIN Paris & North M. GIARD, A. MACHUT, CCLIN S-East C. DUMARTIN, M. PÉFAU, AM. ROGUES, CCLIN S-West S. MAUGAT, S. VAUX, InVS B. SCHLEMMER, AC. CREMIEUX, French Committee for prudent use of antibiotics S. ALFANDARI, R. GAUZIT, French infectious disease society (SPILF) X. BERTRAND, Microbiology, Besançon S. TOURATIER, Pharmacy, GH St Louis, Paris P. LE GONIDEC, Regional observatory for medicines, Paris * Coordinating centres for prevention and control of healthcare associated infections ** French Institute for Public Health Surveillance 9
Results Carbapenem use in 518, 2008-2013 (% change in all carbapenems between 2008 and 2013) 25 20 15 10 5 0 +41% +47% Ertapenem Meropenem Imipenem +56% +61% 2008 2009 2010 2011 2012 2013 2008 2009 2010 2011 2012 2013 2008 2009 2010 2011 2012 2013 2008 2009 2010 2011 2012 2013 Teaching N=18 Public (N=167) Private acute care (N=152) Cancer centres (N=8) Results: ATB-RAISIN, 2013 Carbapenems consumption in number of DDD/1 000 PD (regional pooled mean), in acute care and surveillance coverage (% beds) (N= 668 HCF) 50% 23% 34% 84% 35% 57% 37% 72% 82% 90% 44% 47% 64% 9.6 (P75) consumption < 15.4 (max) 7.1 (P50) consumption < 9.6 (P75) 4.1 (P25) consumption <7.1 (P50) 2.3 (min) consumption < 4.1 (P25) 3% 64% 81% 32% 33% 80% 70% 53% 46% 35% 31% 11% Warning: data from voluntarily participating. Coverage is not homogenous among regions and the number of HCF may be small in some regions. Differences in patients case-mix may partially explain some of the variations in this map. 99% Fait avec Philcarto - http://philcarto.free.fr 10