Nationwide implementation of antibiotic management teams in Belgian hospitals: a self-reporting survey.

OBJECTIVES: Antibiotic management teams (AMTs) have been advocated to optimize the use of antimicrobials in hospitals. Since 2002, the Belgian Antibiotic Policy Coordination Committee (BAPCOC) has supported the development of AMTs in Belgian hospitals with policy guidance and federal funding for antibiotic managers. We performed a national, self-reporting survey to assess the level of AMT activities in 2007. METHODS: A structured questionnaire survey was performed on the composition, organization and service activities of the AMT in all acute care and larger chronic care hospitals in the country in 2007. Descriptive statistics were stratified by duration of AMT funding. RESULTS: Completed questionnaires were provided by 112 of 116 hospitals (response rate, 96.6%). Mutidisciplinary AMTs varied in size (mean 10, range 2-28 members). Antibiotic stewardship tools used by AMTs included: hospital antibiotic formulary (96.3% of hospitals); practice guidelines for antibiotic therapy and surgical prophylaxis (91.6% and 96.3%, respectively); list of 'restricted' antimicrobial agents (75.9%); concurrent review of antibiotic therapies (64.2%); de-escalation of therapy after a few days (63.9%); sequential intravenous/oral therapy for antibiotics with equivalent bioavailability (78.7%); dedicated antimicrobial order forms (36.1%); automatic stop of delivery (43.5%); analysis of antibiotic consumption data (96.2%); and analysis of microbial resistance data (89.8%). CONCLUSIONS: These data demonstrate a well-developed structure of AMTs in Belgian hospitals and the broad range of services provided. Technical and financial support by healthcare authorities was key to the extensive implementation of antimicrobial stewardship programmes across the national hospital care system.

Hospital antibiotic management in Belgium--results of the ABS maturity survey of the ABS International group.

BACKGROUND: While debate about optimal organization for hospital antibiotic stewardship programs is ongoing, limited information is available about the implementation of such programs in acute-care institutions. The ABS International project conducted a survey on the implementation and characteristics of hospital antibiotic management programs in several European countries. This paper summarizes the results for Belgium, where a federal program for developing multidisciplinary antibiotic management teams was started in 2002. METHODS: The survey was conducted in April and May 2007. A questionnaire with 39 items to be scored from 0 (absent) to 5 (fully available) was sent to medical directors and chairs of drugs and therapeutics committees in all acute-care hospitals to measure five dimensions of hospital antibiotic management. The results were analyzed by calculating the mean scores for the various items and topics. MAIN FINDINGS: Of 120 questionnaires sent, 46 (38%) were completed and returned in time for analysis. The three regions of the country were well represented by the respondents. The mean country maturity score of 3.75 (range 2.15-4.90) indicated that a well developed antibiotic management system was in place in most hospitals. Over 90% of hospitals had key structural resources and tools available for effective stewardship programs. Performance items that scored high were those related to microbiological diagnostics and surveillance of bacterial resistance (4.41), surveillance of antibiotic consumption (4.16) and organization of antibiotic guidance and support by trained antibiotic management officers (3.81). Items that scored lower were professional development of personnel (3.43) and co-ordination with outside healthcare providers (2.95). Hospitals with several years of funding for their antibiotic officer showed higher scores for antibiotic management but not for diagnostics. CONCLUSIONS: Antibiotic stewardship programs are well developed in Belgian hospitals, particularly in those which first qualified for federal support. Extension of funding and technical assistance should help all hospitals to catch up with excellence standards, provided that adequate support is given to laboratory services and advanced training of professional specialists.

Antibiotic prophylaxis for children with primary vesicoureteral reflux: where do we stand today?

The main goal of the management of vesicoureteral reflux (VUR) is prevention of recurrent urinary tract infections (UTIs), and thereby prevention of renal parenchymal damage possibly ensuing from these infections. Long-term antibiotic prophylaxis is common practice in the management of children with VUR, as recommended in 1997 in the guidelines of the American Urological Association. We performed a systematic review to ascertain whether antibiotics can be safely discontinued in children with VUR and whether prophylaxis is effective in the prevention of recurrent UTIs and renal damage in these patients. Several uncontrolled studies indicate that antibiotic prophylaxis can be discontinued in a subset of patients, that is, school-aged children with low-grade VUR, normal voiding patterns, kidneys without hydronephrosis or scars, and normal anatomy of the urogenital system. Furthermore, a few recent randomized controlled trials suggest that antibiotic prophylaxis offers no advantage over intermittent antibiotic therapy of UTIs in terms of prevention of recurrent UTIs or new renal damage.

National campaigns to improve antibiotic use.

High levels of antibiotic consumption are driving levels of bacterial resistance that threaten public health. Nonetheless, antibiotics still provide highly effective treatments for common diseases with important implications for human health. The challenge for public education is to achieve a meaningful reduction in unnecessary antibiotic use without adversely affecting the management of bacterial infections. This paper focuses on the lessons learned from national campaigns in countries (Belgium and France) with high antibiotic use. Evaluation of these national campaigns showed the importance of television advertising as a powerful medium to change attitudes and perhaps also behaviour with regard to antibiotics. Moreover, in both countries, strong evidence suggested reduced antibiotic prescribing. However, adverse effects associated with a reduction in antibiotic prescribing were not monitored. We conclude that carefully designed mass education campaigns could improve antibiotic use nationally and should be considered in countries with high antibiotic use. However, these campaigns should employ techniques of social marketing and use appropriate outcome measures. The benefits and risks of such campaigns have been less well established in countries where antibiotic use is already low or declining.