Measuring antimicrobial consumption Katja de With Division of Infectious Diseases University Hospital Carl Gustav Carus at the TUD Dresden © by author ESCMID Postgraduate Education Course Antimicrobial Stewardship: a Practical and ESCMID Online Lecture LibraryIntegrated Approach Antimicrobial consumption What to measure? How to measure? Why to measure? © by author ESCMID Online Lecture Library Antimicrobial consumption What to measure? • Antibacterials • Antimycotics Antiinfectives • Antimycobacterials • Antivirals © by author for: ESCMID• systemic Onlineuse Lecture Library • (local use) © by author ESCMID Online Lecture Library © by author ESCMID Online Lecture Library © by author ESCMID Online Lecture Library ATC/DDD-Index (WHO) J ANTIINFEKTIVES FOR SYSTEMIC USE 1st level, anatomical main group J01 ANTIBACTERIALS FOR SYSTEMIC USE 2nd level, therapeutic subgroup J01C BETA-LACTAM ANTIBACTERIALS, 3rd level, pharmacological PENICILLINS subgroup J01CR Combinations of penicillins, incl. beta-lactamase 4th level, chemical subgroup inhibitors J01CR01 ampicillin and enzyme inhibitor 5th level, chemical substance J01CR04 sultamicillin (o) © by author5th level , chemical substance J01CR02 amoxicillin and enzyme inhibitor 5th level, chemical substance J01CR02 amoxicillin and enzyme inhibitor 5th level, chemical substance J01CR05ESCMIDpiperacillin and enzyme Onlineinhibitor Lecture5th level , chemicalLibrarysubstance ATC/DDD-Index and pitfalls J01 D other beta-lactams • cephalosporins • carbapenems J01 C beta-lactam antibacterials, penicillins © by author ESCMID• aminopenicillins Online Lecture Library • ureidopenicillins Antimicrobial consumption methods • daily doses/1000 inhabitants/day (outpatient) • packages/1000 inhabitants/day (outpatient) • daily doses/100© by hospital author days (inpatient) • daily doses/100 cases (inpatient) ESCMID Online Lecture Library definition of daily dose DDD: defined daily dose (www.whocc.no) is the assumed average maintenance dose per day for a drug used for its main indication in adults. RDD: recommended daily dose (www.antiinfektiva-surveillance.de) „German approach©“ tobyaccount authorfor guideline - recommended dosing („more realistic“) PDDESCMID: prescribed Onlinedaily d Lectureoses Library de With et al., 2009 ATC/DDD Index © by author ESCMID Online Lecture Library Definition of daily doses DDD = Defined Daily Dose (ATC/DDD-Index) RDD = Recommended Daily Dose (www.antiinfektiva-surveillance.de) DDD RDD cefuroxime © by author3 g iv 4,5 g iv cefuroxime 0,5 g po 1 g po ESCMIDceftazidime Online Lecture4 g iv Library6 g iv ampicillin/sulbactam 2 g iv 6 g iv flucloxacillin 2 g iv 8 g iv DDD vs RDD vs PDD preferable PDD Germany: preferable RDD because... DDD overestimate hospital antibiotic consumption especially of beta-lactames © by author ESCMIDDDD for international Online Lecture comparisons Library Calculation of antimicrobial consumption Drug usage in DDD = Number of units x Amount of drug per unit DDDdrug © by author ESCMID Online Lecture Library Calculation of antimicrobial consumption Drug usage in DDD = Number of units x Amount of drug per unit DDDdrug DDD (drug usage Cefuroxime) = 200 (infusions) x 1,5 g © by author3 g (DDD for Cefuroxime) ESCMID Online Lecture Library Exercise I hospital A: 1500 infusions flucloxacillin (2g) I hospital B: 1500 infusions cefuroxime (1,5g) hospital A (flucloxacillin) flucloxacillin IV cefuroxime IV hospital B (cefuroxime) DDD 2 g 3 g © by authorRDD 8 g 4,5 g number ESCMID Online LectureDDD Library number RDD infusions Use density use density DDD/100 hospital days only use density is eligible for comparisons © by author ESCMID Online Lecture Library Exercise I hospital A: 1500 infusions Flucloxacillin (2g), 58000 care days I hospital B: 1500 infusions Cefuroxim (1,5g), 22000 care days flucloxacillin IV cefuroxime IV hospital A (flucloxacillin) (hospital A) (hospital B) hospital B (cefuroxime) DDD 2 g 3 g © by authorRDD 8 g 4,5 g number 1500 750 DDD number ESCMID Online Lecture Library375 500 RDD DDD/100 RDD/100 DDD vs „RDD“ © by author ESCMID Online Lecture Library Haug et al., 2013 Where to evaluate antimicrobial consumption at hospital? hospital overall separate high-consumer-areas • Urology • ENT • Intensive care units© by author • hematology/onkology ESCMID Online Lecture Library …how often evaluate antimicrobial consumption??? yearly quarterly © by author ESCMIDmonthly Online Lecture Library www.antiinfektiva-surveillance.de Antibiotic Stewardship at the ICU © by author ESCMID Online Lecture Library Summary Daily doses per 100 hospital days Hospital-wide, for individual departments and at ward level specific antibiotic classes Top 15 antibiotics© by author parenteral vs. oral ESCMID Online Lecture Library .