Use of broad spectrum antibiotics in six non-university Swiss hospitals

Principles: Broad-spectrum antibiotics (BSAs) are costly and prone to misus e. Their use is associated with the emergence of resistant bacteria. This a rticle describes the first step of all interhospital programme for the appr opriate use of BSAs. Methods: BSAs were defined as the iv antibiotics present in the formulary s hared by the six participating institutions and considered to be antipseudo monal agents (i.e. cefepime, ceftazidime, ciprofloxacin, imipenem, meropene m, piperacillin/tazobactam) plus trovafloxacin. Annual utilisation rates an d interhospital comparisons were provided to each institution using the "de fined daily dosages" (DDDs) of the World Health Organization. Results: From 1997 to 1999, the overall utilisation rate of BSAs increased from 20.6 treatment days (TD)/1000 patient days (PD) to 36.5 TD/ 1000 PD. S ignificant interhospital differences were detected (range: 12.1 TD/1000PD i n 1997 66.5 TD/1000 PD in 1999). The highest relative risk for treatment wi th any BSA for each individual hospital in comparison to the others was det ermined for 1999 (RR = 2.92; 95% confidence interval: 2.81-3.04). In 1999, the most frequently used BSAs were cefepime, imipenem, and piperacillin/taz obactam respectively. Conclusions: Although this programme does not provide information oil the i ndications for using BSAs in various hospitals, it helps to identify those institutions where the selection pressure for resistant bacteria is highest , and that could particularly benefit from specific interventions aiming at decreasing this pressure and controlling drug expenditure. Moreover, the f eedback Of Utilisation rates and interhospital comparisons to the prescribi ng physicians might have a Positive impact on BSA use.