Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015

1. vvvv
Antibiotic consumption in hospitals:
hospital sector definition in France
Acute care hospitals and others…
February 2015

2. Surveillance ATB-RAISIN in France
• Objectives
 To describe antibiotic consumption in French HCF at
hospital and at ward level
• tool for benchmarking
• analysis of consumption data against antimicrobial resistance rates
• improvement at the hospital level and at the national level
 To monitor trends

3. Hospital sector in France ?
Different kind of HCF
• Hospitals, public or private,
with inpatients +/- outpatients
• Home-care hospitals (HAD)
 Part of conventional hospitals
• Dialysis centers
• Others…
Type N
CHUniversity 81
CH
% acute care beds from 0 to100% 570
MCO 669
CLCC 20
HIA 9
ESSR 738
LOC now CH 255
ESLD 46
PSY 247
Total 2 636

4. • LTCF are not nursing homes
 LTCF providing « little » medical care became
« nursing homes »

5. Data collection in the hospital
sector
• ESAC-Net
 Hospital sector as a
whole (100%): sales
data from ANSM
• ATB-Raisin
 Hospital-based
 Voluntarily
participation (1488 in
2013)

6. Data collection in the hospital sector
• Scope of surveillance : All HCF with inpatients
 HCF performing acute care
• Teaching or not, public or private
May include non acute care wards
• Specialised in cancer treatment
 AND HCF performing non acute care
• rehabilitation centres, long term-care HCF (not NH),
psychiatric centres

7. Data collection in the hospital sector
• In the participating HCF: Inpatients only
• Outpatient, day-care, dialysis excluded
• Detailed by ward/clinical activity (76% of HCF)
 Acute care = Medicine, Surgery, ICU, gyneacology, and
paediatrics
 Non acute care = rehabilitation, long-term care &
psychiatry

8. Data collection in the hospital sector
• Rationale for scope of surveillance
• All HCF: information on prudent antibiotic use
First step before tailored activity to ensure prudent use of AB
• Inpatients only: in accordance to denominator
Outpatients wards: not all HCF

9. ATB-Raisin participants
Type N n %
CHU 81 40 49
CH 570 393 69
MCO 669 423 63
CLCC 20 13 65
HIA 10 8 80
ESSR 738 342 46
LOC 255 125 49
ESLD 46 18 39
PSY 247 126 51
Total 2 636 1 488 56

10. ATB-Raisin participants
Type n No. PD %
CHU 40 11 513 046 14%
CH 393 35 722 232 43%
MCO 423 13 594 617 16%
CLCC 13 436 422 1%
HIA 8 465 618 1%
ESSR 342 10 154 373 12%
LOC 125 2 099 228 3%
ESLD 18 417 964 1%
PSY 126 8 305 309 10%
Total 1 488 82 708 809 100%

11. Data collection in the hospital sector
• Antibiotics for systemic use
 Dispensed by the pharmacy for inpatients only
NB: no dispensing for discharged patients in France
• Administrative data
 Denominator consistent with scope of surveillance
• number of patients-days (PD) for inpatients only
 “Journée d’hospitalisation” for stay > 24 h
(different from « one-day stay » < 24h)
• number of “direct” admissions (acute care only)
 Only one admission for one patient admitted for at least 24 h, even if transferred from
ICU to medicine
• Administrative definitions for “Journée d’hospitalisation” and “direct admission”

12. Data presentation
• Antibiotic consumption:
 global use (pooled or weighted mean)
 and distribution in no. DDD/ 1000 PD (and /100 AD for
acute care wards)
 According to HCF type
 According to ward/clinical activity
• (very) detailed tables

13. 020040060080010001200
Teaching
hospital
N=40
Non
teaching
public
hospital<=33
N=73
Non
teaching
public
hospital>33
N=320
Non
teaching
private
hospital
N=423
Cancer
hospital
N=13
Military
hospital
N=8
Rehab
centre
N=342
Local
hospital
N=125
Long
term
care
N=18
Psychiatric
hospital
N=126
NumberofDDD/1000PD
Data presentation: ATB RAISIN, 2013
• Total antibiotic use in 1 488 HCF: 377 DDD/1000 PD
 Variations in total antibiotic use according to HCF type
Outlier
Highest value still within
P75+1,5(P75-P25)
P75
Pooled mean
Median
P25
Lowest value still within
P25-1,5(P75-P25)

14. 020040060080010001200
>66%
N=597
]33-66%]
N=222
]0-33%]
N=148
0%
N=521
% of acute care beds
NumberofDDD/1000PD
Data presentation: ATB RAISIN, 2013
• Total antibiotic use in 1 488 HCF
 Variations in antibiotic use / % acute care beds
Outlier
Highest value still within
P75+1,5(P75-P25)
P75
Pooled mean
Median
P25
Lowest value still within
P25-1,5(P75-P25)

15. 0100020003000
Medicine
N=560
Hematology
N=25
Infectious
diseases
N=13
Surgery
N=447
Intensive
care
N=178
Gynae-
cology
N=296
Paediatrics
N=205
Rehabi-
litation
N=758
Long
term care
N=304
Psychiatry
N=211
NumberofDDD/1000PD
Data presentation: ATB RAISIN, 2013
 Variations in total antibiotic use according to ward/clinical activity

16. Esac-Net hospital based survey
 Objectives
• Comparisons of patterns, quantity between hospitals from
different countries
 Relevant settings for comparisons
• acute care wards, ICUs?
• Including paediatrics?
• Inpatients only?
 Challenges: exclusion of non acute care wards, of
outpatients…

17. More information on antibiotic use in French hospitals
http://www.invs.sante.fr/raisin
http://www.cclin-arlin.fr/