Little information is available on antibiotic prescription management in German hospitals. The objective of this cross-sectional study was to determine the prevalence and components of antibiotic stewardship measures in German intensive care units (ICUs).
A questionnaire survey was sent to all ICUs participating in the German nosocomial infection surveillance system (n = 579) in October 2011. Data on antibiotic management structures were collected and analyzed by structural hospital and ICU factors.
The questionnaire was completed by 355 German ICUs (response rate 61 %). Common measures used (>80 % of the ICUs) were personnel restrictions for antibiotic prescriptions, routine access to bacterial resistance data, and pharmacy reports on antibiotic costs and consumption. A small proportion of ICUs (14 %) employed physicians specialized in the prescription of antimicrobial medication. Hospitals with their own microbiological laboratory report participation in surveillance networks for antimicrobial use (34 %) and bacterial resistance (32 %) twice as often as hospitals with external laboratories (15 and 14 %, respectively, p < 0.001). Also, non-profit and public hospitals participate more often in surveillance networks for bacterial resistance than private hospitals (>23 % vs. 11 %, p < 0.05).
While the majority of ICUs report to have some antibiotic policies established, the contents and composition of these policies vary. Organizational-level control strategies to improve antibiotic management are common in Germany. However, strategies widely considered effective, such as the systematic cross-institutional surveillance of antimicrobial use and bacterial resistance in a standardized manner or the employment of infectious disease specialists, are scarce. This study provides a benchmark for future antibiotic stewardship programs.
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Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013;4:CD003543.
Paskovaty A, Pflomm JM, Myke N, Seo SK. A multidisciplinary approach to antimicrobial stewardship: evolution into the 21st century. Int J Antimicrob Agents. 2005;25:1–10.
Wagenlehner FM, Hoyme U, Kaase M, Fünfstück R, Naber KG, Schmiemann G. Uncomplicated urinary tract infections. Dtsch Arztebl Int. 2011;108:415–23.
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27–72.
Hohmann C, Eickhoff C, Radziwill R, Schulz M. Adherence to guidelines for antibiotic prophylaxis in surgery patients in German hospitals: a multicentre evaluation involving pharmacy interns. Infection. 2012;40:131–7.
van der Velden LB, Tromp M, Bleeker-Rovers CP, Hulscher M, Kullberg BJ, Mouton JW, et al. Non-adherence to antimicrobial treatment guidelines results in more broad-spectrum but not more appropriate therapy. Eur J Clin Microbiol Infect Dis. 2012;31:1561–8.
George P, Morris AM. Pro/con debate: Should antimicrobial stewardship programs be adopted universally in the intensive care unit? Crit Care. 2010;14:205.
MacDougall C, Polk RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev. 2005;18:638–56.
Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44:159–77.
Pope SD, Dellit TH, Owens RC, Hooton TM. Results of survey on implementation of Infectious Diseases Society of America and Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Infect Control Hosp Epidemiol. 2009;30:97–8.
Prins JM, Degener JE, de Neeling AJ, Gyssens IC. Experiences with the Dutch Working Party on antibiotic policy (SWAB). Euro Surveill. 2008;13. pii: 19037.
Kern WV, Steib-Bauert M, Amann S, Fellhauer M, de With K. Hospital antibiotic management in Germany—results of the ABS maturity survey of the ABS International group. Wien Klin Wochenschr. 2008;120:294–8.
Gastmeier P, Sohr D, Schwab F, Behnke M, Zuschneid I, Brandt C, et al. Ten years of KISS: the most important requirements for success. J Hosp Infect. 2008;70:11–6.
Meyer E, Sohr D, Gastmeier P, Geffers C. New identification of outliers and ventilator-associated pneumonia rates from 2005 to 2007 within the German Nosocomial Infection Surveillance System. J Hosp Infect. 2009;73:246–52.
WHO global strategy for containment of antimicrobial resistance. 2001. http://whqlibdoc.who.int/hq/2001/WHO_CDS_CSR_DRS_2001.2.pdf. Accessed 2 Aug 2013.
ECDC. Antimicrobial resistance surveillance in Europe 2011. 2012. http://www.ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-surveillance-europe-2011.pdf. Accessed 2 Aug 2013.
Critchley IA, Karlowsky JA. Optimal use of antibiotic resistance surveillance systems. Clin Microbiol Infect. 2004;10:502–11.
Larson EL, Quiros D, Giblin T, Lin S. Relationship of antimicrobial control policies and hospital and infection control characteristics to antimicrobial resistance rates. Am J Crit Care. 2007;16:110–20.
Meyer E, Gastmeier P. Surveillance of antibiotic use and resistance. Anasthesiol Intensivmed Notfallmed Schmerzther. 2007;42:116–20.
Carbonne A, Arnaud I, Maugat S, Marty N, Dumartin C, Bertrand X, et al. National multidrug-resistant bacteria (MDRB) surveillance in France through the RAISIN network: a 9 year experience. J Antimicrob Chemother. 2013;68:954–9.
Fridkin SK, Lawton R, Edwards JR, Tenover FC, McGowan JE Jr, Gaynes RP. Monitoring antimicrobial use and resistance: comparison with a national benchmark on reducing vancomycin use and vancomycin-resistant enterococci. Emerg Infect Dis. 2002;8:702–7.
Chaberny IF, Wriggers A, Behnke M, Gastmeier P. Antibiotics: MRSA prevention measures in German hospitals: results of a survey among hospitals, performed as part of the MRSA-KISS module. Dtsch Arztebl Int. 2010;107:631–7.
Kuster SP, Ruef C, Ledergerber B, Hintermann A, Deplazes C, Neuber L, et al. Quantitative antibiotic use in hospitals: comparison of measurements, literature review, and recommendations for a standard of reporting. Infection. 2008;36:549–59.
KRINKO. Surveillance nosokomialer Infektionen sowie die Erfassung von Erregern mit speziellen Resistenzen und Multiresistenzen § 6 Abs. 3 und § 23 Abs. 1 und 2 in Verbindung mit § 4 Abs.2 Nr. 2b IfSG. Rechtliche Voraussetzungen und Umsetzungsempfehlungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2000;43:887–90.
KRINKO. Surveillance nosokomialer Infektionen sowie die Erfassung von Krankheits-erregern mit speziellen Resistenzen und Multiresistenzen. Fortschreibung der Liste der gemäß §4 Abs. 2 Nr.2 Buchstabe b in Verbindung mit §23 Abs.4 IfSG zu erfassenden nosokomialen Infektionen und Krankheitserreger mit speziellen Resistenzen und Multiresistenzen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:580–3.
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;6:CD000259.
Woodward RS, Medoff G, Smith MD, Gray JL 3rd. Antibiotic cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital. Am J Med. 1987;83:817–23.
Frank MO, Batteiger BE, Sorensen SJ, Hartstein AI, Carr JA, McComb JS, et al. Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clin Perform Qual Health Care. 1997;5:180–8.
John JF Jr, Fishman NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis. 1997;24:471–85.
McGowan JE Jr. Do intensive hospital antibiotic control programs prevent the spread of antibiotic resistance? Infect Control Hosp Epidemiol. 1994;15:478–83.
Gould IM. A review of the role of antibiotic policies in the control of antibiotic resistance. J Antimicrob Chemother. 1999;43:459–65.
Cooke FJ, Choubina P, Holmes AH. Postgraduate training in infectious diseases: investigating the current status in the international community. Lancet Infect Dis. 2005;5:440–9.
Schweickert B, Kern WV, de With K, Meyer E, Berner R, Kresken M, et al. Surveillance of antibiotic consumption: Clarification of the “definition of data on the nature and extent of antibiotic consumption in hospitals according to section sign 23 paragraph 4 sentence 2 of the IfSG”. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:903–12.
Bruce J, MacKenzie FM, Cookson B, Mollison J, van der Meer JW, Krcmery V, et al. Antibiotic stewardship and consumption: findings from a pan-European hospital study. J Antimicrob Chemother. 2009;64:853–60.
Zoutman DE, Ford BD. The relationship between hospital infection surveillance and control activities and antibiotic-resistant pathogen rates. Am J Infect Control. 2005;33:1–5.
We thank all physicians and nurses in the participating hospitals who provided their antibiotic management data to KISS and Alexander Gropmann for programming the questionnaire survey. This work was supported by the German Ministry of Health (grant number IIA5-2511FSB106/321-4532-04/21). Data have been generated as part of the routine work of the nosocomial infection surveillance system (NRZ KISS).
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The authors declare that they have no conflicts of interest.
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Maechler, F., Schwab, F., Geffers, C. et al. Antibiotic stewardship in Germany: a cross-sectional questionnaire survey of 355 intensive care units. Infection 42, 119–125 (2014). https://doi.org/10.1007/s15010-013-0531-y