Inappropriate use of antibiotics as a major cause of antibiotic resistance

Bacteria can become resistant to the effects of antibiotics, meaning that they can no longer be killed by these medicines. This resistance has become a major problem in healthcare. Indeed, around 33,000 people die every year in Europe as a result of infection due to antibiotic-resistant bacteria. In Belgium, there are an estimated 530 deaths every year1. The inappropriate use of antibiotics is a major cause of bacteria developing antibiotic resistance. As such, the use of antibiotics must be properly monitored and, where necessary, adapted2. 

The results of a study on the use of antibiotics in Belgian acute hospitals from 2017 show that an estimated 28.1% of the patients in an acute hospital are treated with at least one antibiotic at any given moment. This figure is highest in general university hospitals (30.8%) and within intensive care (52.7%). This is to be expected given that more patients with more serious problems are in general university hospitals and in intensive care. The prevalence in all participating European hospitals was 30.5% (spread among European countries: 15.9-55.6%)3.

The figure below shows the median antibiotic consumption per type of hospital for the period 2012-2017. It has been observed that the median antibiotic consumption remains fairly stable over time, but there is a large variation between hospitals4.

In order to limit resistance to antibiotics, unnecessary use of antibiotics must be avoided. If treatment with antibiotics is necessary, it is recommended to use antibiotics within a narrow spectrum, according to the guidelines (only active against a specific group of bacteria). For example, broad-spectrum antibiotics can be stored for complicated cases where narrow-spectrum antibiotics are not sufficient or no longer work. Nevertheless, the use of broad-spectrum antibiotics remains high (about 30% of total antibiotic use in Belgium, spread between European countries): 16-62%5. The large variation in antibiotic use between acute hospitals and the high consumption of broad spectrum antibiotics are attention points for improvement. The KCE wrote some recommendations concerning a more effective antibiotic policy in Belgium. More information can be found on their website.

 

[1] Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted lifeyearsCassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A, Simonsen GS, et al. Attributable deaths and disability-adjusted lifeyearscaused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-levelmodelling analysis. Lancet Infect Dis 2019;19(1):56-66.

[2] OECD (2018), Stemming the Superbug Tide: Just A Few Dollars More, OECD Publishing, Paris. Available from:OECD (2018), Stemming the Superbug Tide: Just A Few Dollars More, OECD Publishing, Paris. Available from:https://doi.org/10.1787/9789264307599-en.

[3] Plachouras D, Karki T, Hansen S, Hopkins S, Lyytikainen O, Moro ML, et al. Antimicrobial use in European acute care hospitals:Plachouras D, Karki T, Hansen S, Hopkins S, Lyytikainen O, Moro ML, et al. Antimicrobial use in European acute care hospitals:results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. EuroSurveill 2018;23(46). doi: 10.2807/1560-7917.

[4] Source: Belgian Hospitals - Surveillance of Antimicrobial Consumption, Sciensano

[5] The use of antibiotics, in Belgium, is observed via national surveillance (BeH-SAC: Belgian Hospitals – Surveillance of AntimicrobialThe use of antibiotics, in Belgium, is observed via national surveillance (BeH-SAC: Belgian Hospitals – Surveillance of AntimicrobialConsumption). More information about this surveillance can be found via http://www.nsih.be/surv_gm/introduction_en.asp and www.healthstat.be .