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In response to the article by Ticehurst and Thomas1 and the accompanying editorial,2 we describe the antimicrobial consumption data in our hospitals. The data were collected and are presented using internationally accepted methods3 for the adult admissions to Wellington and Kenepuru Hospitals in the calendar year ending October 2010. These sites have a total bed count of 350; 306 beds at Wellington Hospital (including 18 in ICU and 36 in Haematology / Oncology) and 44 beds at Kenepuru. Together the hospitals provide secondary care services to a population of 292,2604 and tertiary services to the wider region.During the audit period there were 26,236 admissions, with 119,182 inpatient days (first and final day of stay counted as one). The average length of stay was 4.54 days. Antimicrobial defined daily doses (DDD) were established according to the 2010 version of the WHO ATC/DDD index, and central pharmacy supply information was used to estimate consumption.Overall, Wellington and Kenepuru hospitals used 356.41 DDD per 100 admissions, and 78.46 DDD per 100 patient days,5 during the study period. We estimated consumption of 1.32 DDD per 1000 population, per day.6These figures are comparable to those from Auckland, and both Wellington and Auckland are well within the lowest-quartile of consumption when compared to 2010 Australian figures, which range from 63.3 to 156 DDD per 100 patient days . They also compare well with European counterparts: Denmark reported 78.13 DDD per 100 patient days in 2008.Consumption by drug class is shown in Table 1. There were marked differences between the data from Wellington and Auckland within the drug-classes, reflective of different local antimicrobial guidelines and practices. The DDD per 100 admissions by class, comparing Wellington and Auckland were: combinations of penicillins 35.58 vs 61.8; 2nd and 3rd generation cephalosporins 72.07 vs 29.2; carbapenems 12.04 vs 6.2; aminoglycosides 9.54 vs 19; fluoroquinolones 18.78 vs 9 and glycopeptides 5.95 vs 4.2. It is important to understand antibiotic usage patterns in NZ hospitals, for both financial and ecological reasons. It is beyond the scope of this brief communication to relate antibiotic usage and resistance patterns, but it is interesting to note that there is a steady increase in the prevalence of antibiotic resistance in gram negative organisms (ESR report7), which is reflected in our hospital laboratory data. We can expect an increase in the use of carbapenems as the prevalence of extended spectrum beta-lactamase-producing Escherichia coli and Klebsiellaspp increase. Table 1. Antimicrobial consumption by drug class Antimicrobial Class (ATC) DDD/admission DDD/100 inpatient days Tetracycline (J01AA) Penicillins with extended spectrum (J01CA) Beta-lactamase sensitive penicillins (J01CE) Beta-lactamase resistant penicillins (J01CF) Combinations of penicillins (J01CR) First generation of cephalosporins (J01DB) Second generations of cephalosporin (J01DC) Third generation of cephalosporin (J01DD) Fourth generation cephalosporin (J01DE) Monobactams (J01DF) Carbapenems (J01DH) Trimethoprim (J01EA) Sulphonamides (J01EC) Trimethoprim with sulphonamides (J01EE) Macrolides (J01FA) Lincosamide (J01FF) Aminoglycosides (J01G) Fluoroquinolones (J01MA) Glycopeptides (J01XA) Polymyxins (J01XB) Fusidic acid (J01XC01) Imidazoles (J01XD) Nitrofurans (J01XE) Other agents (J01XX08) 7.36 37.13 4.84 62.76 35.58 15.53 64.08 7.99 0 0 12.04 4.60 0 4.27 30.0 5.55 9.54 18.78 5.95 0.62 0.39 27.69 1.62 0.07 1.62 8.17 1.07 13.82 7.83 3.42 14.11 1.76 0 0 2.65 1.01 0 0.94 6.60 1.22 2.10 4.13 1.31 0.14 0.09 6.09 0.36 0.02 All agents (J01) 356.41 78.46 The data collected here explain the current state of antibiotic consumption in Capital and Coast DHB, and provide a platform from which to launch stewardship measures - perhaps lowering our use of carbapenems and fluoroquinolones to the admirably low levels of consumption achieved in Auckland. We hope that the publication of Auckland and Capital and Coast DHB hospital data will stimulate other hospitals to report their data. National reporting of data is a readily obtainable goal and local data are essential for establishing baseline consumption to drive hospital infection prevention and control programmes. Justin Beardsley ID Registrar, Wellington Hospital Brijul Morar Pharmacist, Wellington Hospital Tim Blackmore ID Physician and Microbiologist, Wellington Hospital

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Justin Beardsley, ID Registrar, Wellington Hospital, Brijul Morar, Pharmacist, Wellington Hospital, Tim Blackmore, ID Physician and Microbiologist, Wellington Hospital

Acknowledgements

We thank Dr Mark Thomas and Mr Rob Ticehurst of Auckland Hospital and Mr Neville Winsley of Wellington Hospital.

Correspondence

Correspondence Email

Competing Interests

Ticehurst R, Thomas M. Antimicrobial consumption at Auckland City Hospital: 2006-2009. N Z Med J. 2011;124(1332).http://journal.nzma.org.nz/journal/124-1332/4602/content.pdfBeardsley J, Blackmore T. Antibiotic prescribing: time for national surveillance? N Z Med J. 2010 Apr 15;124(1332):6-8.http://journal.nzma.org.nz/journal/124-1332/4612/content.pdfKuster et al. Quantitative Antibiotic Use in Hospitals: Comparison of Measurements, Literature Review, and recommendations for a Standard of Reporting. Infection 2008; 36: 549-559.2010 Projection, Stats NZ.http://www.health.sa.gov.au/INFECTIONCONTROL/DesktopModules/SSSA_Documents/LinkClick.aspx?tabid=89&table=SSSA_Documents&field=ItemID&id=514&link=national-antimicrobial-annual-report-2009_10.pdf accessed July 2011.http://www.danmap.org/pdfFiles/Danmap_2009.pdf page 51, accessed July 2011.http://www.surv.esr.cri.nz/PDF_surveillance/Antimicrobial/ESBL/ESBL_2010.pdf accessed August 2011

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

In response to the article by Ticehurst and Thomas1 and the accompanying editorial,2 we describe the antimicrobial consumption data in our hospitals. The data were collected and are presented using internationally accepted methods3 for the adult admissions to Wellington and Kenepuru Hospitals in the calendar year ending October 2010. These sites have a total bed count of 350; 306 beds at Wellington Hospital (including 18 in ICU and 36 in Haematology / Oncology) and 44 beds at Kenepuru. Together the hospitals provide secondary care services to a population of 292,2604 and tertiary services to the wider region.During the audit period there were 26,236 admissions, with 119,182 inpatient days (first and final day of stay counted as one). The average length of stay was 4.54 days. Antimicrobial defined daily doses (DDD) were established according to the 2010 version of the WHO ATC/DDD index, and central pharmacy supply information was used to estimate consumption.Overall, Wellington and Kenepuru hospitals used 356.41 DDD per 100 admissions, and 78.46 DDD per 100 patient days,5 during the study period. We estimated consumption of 1.32 DDD per 1000 population, per day.6These figures are comparable to those from Auckland, and both Wellington and Auckland are well within the lowest-quartile of consumption when compared to 2010 Australian figures, which range from 63.3 to 156 DDD per 100 patient days . They also compare well with European counterparts: Denmark reported 78.13 DDD per 100 patient days in 2008.Consumption by drug class is shown in Table 1. There were marked differences between the data from Wellington and Auckland within the drug-classes, reflective of different local antimicrobial guidelines and practices. The DDD per 100 admissions by class, comparing Wellington and Auckland were: combinations of penicillins 35.58 vs 61.8; 2nd and 3rd generation cephalosporins 72.07 vs 29.2; carbapenems 12.04 vs 6.2; aminoglycosides 9.54 vs 19; fluoroquinolones 18.78 vs 9 and glycopeptides 5.95 vs 4.2. It is important to understand antibiotic usage patterns in NZ hospitals, for both financial and ecological reasons. It is beyond the scope of this brief communication to relate antibiotic usage and resistance patterns, but it is interesting to note that there is a steady increase in the prevalence of antibiotic resistance in gram negative organisms (ESR report7), which is reflected in our hospital laboratory data. We can expect an increase in the use of carbapenems as the prevalence of extended spectrum beta-lactamase-producing Escherichia coli and Klebsiellaspp increase. Table 1. Antimicrobial consumption by drug class Antimicrobial Class (ATC) DDD/admission DDD/100 inpatient days Tetracycline (J01AA) Penicillins with extended spectrum (J01CA) Beta-lactamase sensitive penicillins (J01CE) Beta-lactamase resistant penicillins (J01CF) Combinations of penicillins (J01CR) First generation of cephalosporins (J01DB) Second generations of cephalosporin (J01DC) Third generation of cephalosporin (J01DD) Fourth generation cephalosporin (J01DE) Monobactams (J01DF) Carbapenems (J01DH) Trimethoprim (J01EA) Sulphonamides (J01EC) Trimethoprim with sulphonamides (J01EE) Macrolides (J01FA) Lincosamide (J01FF) Aminoglycosides (J01G) Fluoroquinolones (J01MA) Glycopeptides (J01XA) Polymyxins (J01XB) Fusidic acid (J01XC01) Imidazoles (J01XD) Nitrofurans (J01XE) Other agents (J01XX08) 7.36 37.13 4.84 62.76 35.58 15.53 64.08 7.99 0 0 12.04 4.60 0 4.27 30.0 5.55 9.54 18.78 5.95 0.62 0.39 27.69 1.62 0.07 1.62 8.17 1.07 13.82 7.83 3.42 14.11 1.76 0 0 2.65 1.01 0 0.94 6.60 1.22 2.10 4.13 1.31 0.14 0.09 6.09 0.36 0.02 All agents (J01) 356.41 78.46 The data collected here explain the current state of antibiotic consumption in Capital and Coast DHB, and provide a platform from which to launch stewardship measures - perhaps lowering our use of carbapenems and fluoroquinolones to the admirably low levels of consumption achieved in Auckland. We hope that the publication of Auckland and Capital and Coast DHB hospital data will stimulate other hospitals to report their data. National reporting of data is a readily obtainable goal and local data are essential for establishing baseline consumption to drive hospital infection prevention and control programmes. Justin Beardsley ID Registrar, Wellington Hospital Brijul Morar Pharmacist, Wellington Hospital Tim Blackmore ID Physician and Microbiologist, Wellington Hospital

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Justin Beardsley, ID Registrar, Wellington Hospital, Brijul Morar, Pharmacist, Wellington Hospital, Tim Blackmore, ID Physician and Microbiologist, Wellington Hospital

Acknowledgements

We thank Dr Mark Thomas and Mr Rob Ticehurst of Auckland Hospital and Mr Neville Winsley of Wellington Hospital.

Correspondence

Correspondence Email

Competing Interests

Ticehurst R, Thomas M. Antimicrobial consumption at Auckland City Hospital: 2006-2009. N Z Med J. 2011;124(1332).http://journal.nzma.org.nz/journal/124-1332/4602/content.pdfBeardsley J, Blackmore T. Antibiotic prescribing: time for national surveillance? N Z Med J. 2010 Apr 15;124(1332):6-8.http://journal.nzma.org.nz/journal/124-1332/4612/content.pdfKuster et al. Quantitative Antibiotic Use in Hospitals: Comparison of Measurements, Literature Review, and recommendations for a Standard of Reporting. Infection 2008; 36: 549-559.2010 Projection, Stats NZ.http://www.health.sa.gov.au/INFECTIONCONTROL/DesktopModules/SSSA_Documents/LinkClick.aspx?tabid=89&table=SSSA_Documents&field=ItemID&id=514&link=national-antimicrobial-annual-report-2009_10.pdf accessed July 2011.http://www.danmap.org/pdfFiles/Danmap_2009.pdf page 51, accessed July 2011.http://www.surv.esr.cri.nz/PDF_surveillance/Antimicrobial/ESBL/ESBL_2010.pdf accessed August 2011

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

In response to the article by Ticehurst and Thomas1 and the accompanying editorial,2 we describe the antimicrobial consumption data in our hospitals. The data were collected and are presented using internationally accepted methods3 for the adult admissions to Wellington and Kenepuru Hospitals in the calendar year ending October 2010. These sites have a total bed count of 350; 306 beds at Wellington Hospital (including 18 in ICU and 36 in Haematology / Oncology) and 44 beds at Kenepuru. Together the hospitals provide secondary care services to a population of 292,2604 and tertiary services to the wider region.During the audit period there were 26,236 admissions, with 119,182 inpatient days (first and final day of stay counted as one). The average length of stay was 4.54 days. Antimicrobial defined daily doses (DDD) were established according to the 2010 version of the WHO ATC/DDD index, and central pharmacy supply information was used to estimate consumption.Overall, Wellington and Kenepuru hospitals used 356.41 DDD per 100 admissions, and 78.46 DDD per 100 patient days,5 during the study period. We estimated consumption of 1.32 DDD per 1000 population, per day.6These figures are comparable to those from Auckland, and both Wellington and Auckland are well within the lowest-quartile of consumption when compared to 2010 Australian figures, which range from 63.3 to 156 DDD per 100 patient days . They also compare well with European counterparts: Denmark reported 78.13 DDD per 100 patient days in 2008.Consumption by drug class is shown in Table 1. There were marked differences between the data from Wellington and Auckland within the drug-classes, reflective of different local antimicrobial guidelines and practices. The DDD per 100 admissions by class, comparing Wellington and Auckland were: combinations of penicillins 35.58 vs 61.8; 2nd and 3rd generation cephalosporins 72.07 vs 29.2; carbapenems 12.04 vs 6.2; aminoglycosides 9.54 vs 19; fluoroquinolones 18.78 vs 9 and glycopeptides 5.95 vs 4.2. It is important to understand antibiotic usage patterns in NZ hospitals, for both financial and ecological reasons. It is beyond the scope of this brief communication to relate antibiotic usage and resistance patterns, but it is interesting to note that there is a steady increase in the prevalence of antibiotic resistance in gram negative organisms (ESR report7), which is reflected in our hospital laboratory data. We can expect an increase in the use of carbapenems as the prevalence of extended spectrum beta-lactamase-producing Escherichia coli and Klebsiellaspp increase. Table 1. Antimicrobial consumption by drug class Antimicrobial Class (ATC) DDD/admission DDD/100 inpatient days Tetracycline (J01AA) Penicillins with extended spectrum (J01CA) Beta-lactamase sensitive penicillins (J01CE) Beta-lactamase resistant penicillins (J01CF) Combinations of penicillins (J01CR) First generation of cephalosporins (J01DB) Second generations of cephalosporin (J01DC) Third generation of cephalosporin (J01DD) Fourth generation cephalosporin (J01DE) Monobactams (J01DF) Carbapenems (J01DH) Trimethoprim (J01EA) Sulphonamides (J01EC) Trimethoprim with sulphonamides (J01EE) Macrolides (J01FA) Lincosamide (J01FF) Aminoglycosides (J01G) Fluoroquinolones (J01MA) Glycopeptides (J01XA) Polymyxins (J01XB) Fusidic acid (J01XC01) Imidazoles (J01XD) Nitrofurans (J01XE) Other agents (J01XX08) 7.36 37.13 4.84 62.76 35.58 15.53 64.08 7.99 0 0 12.04 4.60 0 4.27 30.0 5.55 9.54 18.78 5.95 0.62 0.39 27.69 1.62 0.07 1.62 8.17 1.07 13.82 7.83 3.42 14.11 1.76 0 0 2.65 1.01 0 0.94 6.60 1.22 2.10 4.13 1.31 0.14 0.09 6.09 0.36 0.02 All agents (J01) 356.41 78.46 The data collected here explain the current state of antibiotic consumption in Capital and Coast DHB, and provide a platform from which to launch stewardship measures - perhaps lowering our use of carbapenems and fluoroquinolones to the admirably low levels of consumption achieved in Auckland. We hope that the publication of Auckland and Capital and Coast DHB hospital data will stimulate other hospitals to report their data. National reporting of data is a readily obtainable goal and local data are essential for establishing baseline consumption to drive hospital infection prevention and control programmes. Justin Beardsley ID Registrar, Wellington Hospital Brijul Morar Pharmacist, Wellington Hospital Tim Blackmore ID Physician and Microbiologist, Wellington Hospital

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Justin Beardsley, ID Registrar, Wellington Hospital, Brijul Morar, Pharmacist, Wellington Hospital, Tim Blackmore, ID Physician and Microbiologist, Wellington Hospital

Acknowledgements

We thank Dr Mark Thomas and Mr Rob Ticehurst of Auckland Hospital and Mr Neville Winsley of Wellington Hospital.

Correspondence

Correspondence Email

Competing Interests

Ticehurst R, Thomas M. Antimicrobial consumption at Auckland City Hospital: 2006-2009. N Z Med J. 2011;124(1332).http://journal.nzma.org.nz/journal/124-1332/4602/content.pdfBeardsley J, Blackmore T. Antibiotic prescribing: time for national surveillance? N Z Med J. 2010 Apr 15;124(1332):6-8.http://journal.nzma.org.nz/journal/124-1332/4612/content.pdfKuster et al. Quantitative Antibiotic Use in Hospitals: Comparison of Measurements, Literature Review, and recommendations for a Standard of Reporting. Infection 2008; 36: 549-559.2010 Projection, Stats NZ.http://www.health.sa.gov.au/INFECTIONCONTROL/DesktopModules/SSSA_Documents/LinkClick.aspx?tabid=89&table=SSSA_Documents&field=ItemID&id=514&link=national-antimicrobial-annual-report-2009_10.pdf accessed July 2011.http://www.danmap.org/pdfFiles/Danmap_2009.pdf page 51, accessed July 2011.http://www.surv.esr.cri.nz/PDF_surveillance/Antimicrobial/ESBL/ESBL_2010.pdf accessed August 2011

Contact diana@nzma.org.nz
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