Use of antimicrobial agents in the Teaching Hospital of Siena

Background Resistances of ‘‘bugs’’ and the misuse of antimicrobial agents (AA) represent an important public health problems. Multiresistant germs are common in hospital acquired infections (HAI) and are responsible for higher mortality, length of hospital stay and costs. The aims of this study were to determine the use and to estimate which factors are important in determining AA utilization. Methods We conducted a cross sectional study,data collection on the use of AA was carried out in all the wards of the Teaching Hospital ‘‘Le Scotte’’ of Siena on February 2015. A descriptive analysis, followed by univariate and multivariate analysis (logistic regression) were carried out. In addition, comparisons with international literature were made. Results 468 MR were collected. 217 patients received AA. The most common class of AA used was Cephalosporines (26%), followed by Penicillines (17%), Fluoroquinolons (11%), and Carbapenems (10%). 34.6% of AA was given for medical prophylaxis, 29.4% for community infection, 18.6% for surgical prophylaxis and 14.1% for HAI. After multivariate logistic regression the variables which were significant for the use of AA were: ward typology (Surgical wards and Intensive care use less AA than medical wards: respectively OR= 0.39, p = 0.002 and OR= 0.35, p = 0.01), invasive surgery (OR 2.21, p 0.01) and the use of catheters : central venous one OR= 4.73 p < 0.001, peripheral venous one OR= 4.79 p < 0.001 and urinary one OR= 2.13 p = 0.002. Conclusions Our study agree with other European studies regarding the most frequently used AA classes; although we registered a higher use of AA, especially for medical prophylaxis. Ward typology, surgery and the presence of catheters seemed to be the most important variables involved in the use of AA. Key messages We found an antimicrobial agents utilization greater than European data, especially for the medical prophylaxis Ward typology, surgery and the presence of catheters are the most important variables involved in the use of antimicrobial agents