Antibiotikaanwendung in Deutschland im europäischen Vergleich[1]

Summary

In view of increasing rates of antibiotic resistance worldwide and decreased research and development of new antibacterial compounds, programmes helping to better understand the complex relationship between antibiotic consumption and emergence of resistance have gained importance. Consequently, in addition to increased support for research projects that establish prospective surveillance and evaluation of antibiotic resistance and antimicrobial drug use, the EU has passed directives addressing political leadership in this respect. Information on antibiotic use in Germany is now available from databases independent from cost-oriented market research studies. This information allows estimation of antibiotic use in ambulatory and hospital care as compared with to other EU countries. According to results of current projects, the frequency of national antibiotic use in ambulatory care in Germany (4948 defined daily doses per 1000 population per year) falls within the lower third of EU countries. Upper boundaries in regional variation in antibiotic use are still much lower than values for high-use countries like France, Spain and Portugal. Hospital antibiotic use, in contrast, appears to be in the range of that reported for other countries. However, only rough estimates of hospital antibiotic use are available for Germany as well as most other EU countries due to data usually derived from non-representative hospital sampling.

Literatur

• 1 Berning R, Rosenow C. Statistische Krankenhausdaten: Grund- und Kostendaten der Krankenhäuser. Schattauer Verlag In: Arnold M, Klauber J, Schnellschmidt H (eds). Krankenhaus-Report 2002 2002: 225-239
• 2 Berzina S, Ozolins G, Elseviers M. et al . Consumption of antibiotics in Latvia: first results of the ESAC retrospective data collection (abstract).  Clin Microbiol Infect. 2003;  9 360
• 3 Bonten M J, Austin D J, Lipsitch M. Understanding the spread of antibiotic resistant pathogens in hospitals: mathematical models as tools for control.  Clin Infect Dis. 2001;  33 1739-1746
• 4 Cars O, Molstad S, Melander A. Variation in antibiotic use in the European Union.  Lancet. 2001;  357 1851-1853
• 5 Cristino J M. Correlation between consumption of antimicrobials in humans and development of resistance in bacteria.  Int J Antimicrob Agents. 1999;  12 199-202
• 6 de With K, Gonnermann C, Kern W V. Trends in antimicrobial drug use at a German university hospital between 1992 and 1999 (abstract).  Infection. 2002;  29 72
• 7 de With K, Bergner J, Bühner R. et al . Antibiotic use in German university hosptals (project INTERUNI-II).  Int J Antimicrob Agents. 2004;  (in press)
• 8 de With K, Steib-Bauert M, Kern W V. INTERUNI-II: Antibiotikaverbrauch in medizinischen und chirurgischen Universitätskliniken 1998 bis 2000 (abstract).  Infection. 2003;  31 83 (Suppl 1)
• 9 Elseviers M, Ferech M, Vander Stichele R, Goossens H. Consumption of antibiotics in ambulatory care in Europe: first results of the ESAC retrospective data (abstract).  Clin Microbiol Infect. 2003;  9 33
• 10 Enne V I, Livermore D M, Stephens P, Hall L M. Persistence of sulphonamide resistance in Escherichia coli in the UK despite national prescribing restriction.  Lancet. 2001;  357 1325-1328
• 11 Europäische Union .Empfehlung des Rates vom 15. November 2001 zur umsichtigen Verwendung antimikrobieller Mittel in der Humanmedizin. Amtsblatt der Europäischen Gemeinschaften (2002/77/EG) 2002: L 34-13-L 34/16
• 12 European Federation of Animal Health (FEDESA) .Antibiotics and animals. FEDESA/FEFANA Press release. Brussels, Belgium 8 September 1997
• 13 European Federation of Animal Health (FEDESA) .Antibiotic use in farm animals does not threaten human health. FEDESA/FEFANA Press release. Brussels, Belgium 13 July 2001
• 14 Fridkin S K, Steward C D, Edwards J R. et al . Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: project ICARE phase 2. Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals.  Clin Infect Dis. 1999;  29 245-252
• 15 Guillemot D, Courvalin P. Better control of antibiotic resistance.  Clin Infect Dis. 2001;  33 542-547
• 16 Günther J, Kern W V, Nink K. et al .Solange sie noch wirken. Analysen und Kommentare zum Antibiotikaverbrauch in Deutschland. WIdO Bonn/Universität Freiburg 2003
• 17 Hermosilla N L, Canut B A, Ulibarrena S M. et al . Trends in antimicrobial utilization at a Spanish general hospital during a 5-year period.  Pharmacoepidemiol Drug Saf. 2003;  12 243-247
• 18 Janknegt R, Filius M, Liem Y. et al . Consumption of antibiotics in the Netherlands: first results of the ESAC retrospective data collection (abstract).  Clin Microbiol Infect. 2003;  9 361
• 19 Janknegt R, Wijnands W J, Caprasse M. et al . Antimicrobial drug use in hospitals in the Netherlands, Germany and Belgium.  Eur J Clin Microbiol Infect Dis. 1993;  12 832-838
• 20 Kern W V, de With K, Trautmann M. et al . Glycopeptide use at four university hospitals in southern Germany.  Infection. 2002;  30 262-266
• 21 Kern W V, de With K, Gonnermann C. et al . Update on glycopeptide use in German university hospitals.  Infection. 2004;  (in press)
• 22 Kern W V, Rose A D, Hay B. et al . Antimicrobial expenditures and usage at four university hospitals. Baden-Württemberg Interuniversity Study Group.  Infection. 2001;  29 127-137
• 23 Levin B R. Minimizing potential resistance: a population dynamics view.  Clin Infect Dis. 2001;  33 S161-S169 (Suppl 3)
• 24 Lipsitch M, Bergstrom C T, Levin B R. The epidemiology of antibiotic resistance in hospitals: paradoxes and prescriptions.  Proc Natl Acad Sci U S A. 2000;  97 1938-1943
• 25 Meyer E, Jonas D, Schwab F. et al . Design of a surveillance system of antibiotic use and bacterial resistance in German intensive care units (SARI).  Infection. 2003;  31 208-215
• 26 Molstad S, Lundborg C S, Karlsson A K, Cars O. Antibiotic prescription rates vary markedly between 13 European countries.  Scand J Infect Dis. 2002;  34 366-371
• 27 Monnet D L, Archibald L K, Phillips L. et al . Antimicrobial use and resistance in eight US hospitals: complexities of analysis and modeling. Intensive Care Antimicrobial Resistance Epidemiology Project and National Nosocomial Infections Surveillance System Hospitals.  Infect Control Hosp Epidemiol. 1998;  19 388-394
• 28 Monnet D L, Sorensen T L. Interpreting the effectiveness of a national antibiotic policy and comparing antimicrobial use between countries.  J Hosp Infect. 1999;  43 239-242
• 29 Naaber P, Koljalg S, Maimets M. Antibiotic usage and resistance - trends in Estonian university hospitals.  Int J Antimicrob Agents. 2000;  16 309-315
• 30 Petersen I S, Hesselbjerg L, Jorgensen L. et al . High antibiotic consumption in Danish intensive care units?.  APMIS. 1999;  107 989-996
• 31 Rüden H, Gastmeier P, Daschner F D, Schumacher M. Nosocomial and community-acquired infections in Germany. Summary of the results of the first national prevalence study (NIDEP).  Infection. 1997;  25 199-202
• 32 Schindler C, Krappweis J, Morgenstern I, Kirch W. Prescriptions of systemic antibiotics for children in Germany aged between 0 and 6 years.  Pharmacoepidemiol Drug Saf. 2003;  12 113-120
• 33 Schrag S J, Perrot V. Reducing antibiotic resistance.  Nature. 1996;  381 120-121
• 34 Schrag S J, Perrot V, Levin B R. Adaptation to the fitness costs of antibiotic resistance in Escherichia coli.  Proc R Soc Lond B Biol Sci. 1997;  264 1287-1291
• 35 Schröder H, Nink K, Günther J, Kern W V. Antibiotika: solange sie noch wirken.  Gesundheit und Gesellschaft Wissenschaft. 2003;  3 7-16
• 36 Union of Concerned Scientists .70 percent of all antibiotics given to healthy livestock. Press release. Cambridge, MA, USA 8 January 2001
• 37 van den Bogaard A EJM. Antimicrobial resistance - relation to human and animal exposure to antibiotics.  J Antimicrob Chemother. 1997;  40 453-454
• 38 Vlahovic-Palcevski V, Morovic M, Palcevski G. Antibiotic utilization at the university hospital after introducing an antibiotic policy.  Eur J Clin Pharmacol. 2000;  56 97-101
• 39 von Ferber L, Schubert I, Ihle P. et al .Wie viel Arzneimittel (ver)braucht der Mensch? Arzneiverbrauch in der Bevölkerung: Behandlungshäufigkeit, Therapiedauer und Verordnungsanlässe. WIdO Bonn 1996
• 40 Walther S M, Erlandsson M, Burman L G. et al . Antibiotic prescription practices, consumption and bacterial resistance in a cross section of Swedish intensive care units.  Acta Anaesthesiol Scand. 2002;  46 1075-1081
• 41 Witte W. Medical consequences of antibiotic use in agriculture.  Science. 1998;  279 996-997
• 42 Zanetti G, Goldie S J, Platt R. Clinical consequences and cost of limiting use of vancomycin for perioperative prophylaxis: example of coronary artery bypass surgery.  Emerg Infect Dis. 2001;  7 820-827

1 Die hier dargestellten Forschungsprojekte wurden finanziell unterstützt durch die Meta-Alexander-Stiftung, durch die BMBF-Förderprogramme 01 KI 9951 und 01 KI 9907 sowie durch die EU (SI2.325736). H. Schröder und W. V. Kern sind die Vertreter Deutschlands innerhalb des Forschungsnetzwerks „European Surveillance of Antibiotic Consumption” (ESAC).