Surveillance of antimicrobial consumption has been identified as a key component in the WHO Global Action Plan on Antimicrobial Resistance. The Health Protection Surveillance Centre (HPSC) participates in the European Surveillance of Antimicrobial Consumption Network (EASC-Net), which aims to construct an inventory of antimicrobial consumption in the EU, by collating data from both outpatient (primary care or community) and hospital care areas.

HPSC recently published the latest hospital antimicrobial consumption report. The report contains useful links, a national overview, breakdown by individual hospitals and hospital groups, along with methods and limitations. The main findings are:

• The median* antimicrobial consumption for 42 acute public hospitals remained stable for 2015; 82.1 defined daily doses (DDD) per 100 bed days used (BDU), compared to 82.0 in 2014
• The overall mean* decreased to 83.7 DDD per 100 BDU in 2015 from 85.0 in 2014
• Consumption of penicillins of all subclass had been increasing steadily but has stabilised to 49.3% of overall use in 2015
  • Use of broad spectrum combinations of penicillin with enzyme (such as co-amoxiclav) accounts for over 60% of all penicillin use
  • Consumption of fluoroquinolones (such as ciprofloxacin) has nearly halved since 2008 and decreased to 6% of overall use in 2015
  • Consumption of carbapenems (such as meropenem and ertapenem) has tripled since 2008 and peaked at 3.8 DDD per 100 BDU (representing 4.5% of overall use) in 2014, with the figure for 2015 unchanged

*the median is a better indicator for comparing usage at whole hospital level, while the mean is better suited for assessing national usage by antimicrobial classes

Antimicrobial consumption is associated with the development and spread of antimicrobial resistance, and consumption of carbapenems, in particular, has been linked to the emergence of carbapenem-resistant Enterobacteriaceae (CRE). Antimicrobial use is also a major risk factor for Clostridium difficile infection. While stable antimicrobial consumption in Irish hospitals is an encouraging finding, it is the responsibility of every healthcare worker, including those who prescribe, dispense and administer antimicrobials to ensure prudent and guideline-compliant antimicrobial use is embedded in their daily clinical practice. The recently-published final report from the Review on Antimicrobial Resistance, commissioned by the United Kingdom Government and the Wellcome Trust highlights the serious global issue of increasing antimicrobial resistance and potential solutions to address the problem. The full report is available at the following weblink: http://amr-review.org/Publications

Please visit the HPSC website for more information on antibiotics.

Ajay Oza, Karen Burns and Robert Cunney, HPSC.

Acknowledgements:

The authors would like to acknowledge the work and support of  antimicrobial stewardship teams in the participating hospitals