Antimicrobial consumption in Albanian reference teaching hospital (2012-2015)

Dear Editor, Human antibiotic consumption has been increasing globally with the greatest increase being observed in low and middle income countries (LMICs). Despite an estimated 80% of use being attributed to the community, where both prescribed and over the counter (OTC) use are common, especially in LMICs, the volume of patients with serious medical conditions in hospitals and the resultant high density of antibiotic use in such institutions, makes hospital antibiotic use disproportionately important [1]. A recent publication from Albania showed the combined community and hospital consumption in Albania for 2011-2012 [2]. However, in a recent World Health Organization (WHO) European Region (WHO/Euro) press release no data from Albania was reported [3]. LMICs generally lack resources for surveillance of antimicrobial consumption rendering any antimicrobial stewardship initiatives more difficult. We assessed the feasibility and reliability of hospital antimicrobial distribution data between the years 2012-2015 at the University Hospital Centre ‘Mother Teresa’ of Tirana (QSUT), which is the major Hospital Centre in Albania. This is the only tertiarycare referral centre for acute and critical patients in Albania, a hospital with over 1500 beds, of which, more than 100 are classified as intensive-care. Data is reported using the 2016 WHO Anatomical Therapeutic Chemical (ATC) Classification System and defined daily dose (DDD) methodology, the gold standard for international drug utilization research studies. Data for ATC codes A07AA (Intestinal Antibiotics), J01 (Antibacterials for Systemic Use), J02 (Antimycotics for Systemic Use), J04 (Antimycobacterials), J05 (Antiviral agents) and P01AB (nitroimidazole derivatives) were recorded by ATC code and route of administration. Consumption data were obtained from the QSUT central distribution pharmacy. In addition, data on occupied beds (OBD) and admissions were also collected from Hospital administration. Total Albanian population could not be used as a denominator because QSUT does not represent 100% of hospital beds in Albania. For the different drug classes presenting a simple comparison of the slopes of regression lines would have been misleading [4]. In order to compare the change in each class over time, the slopes (trends) were scaled with their intercepts (baselines) to produce the mean annual change using the following formula which was adapted from Ansari and colleagues: % Δ Variable = (slope/intercept)×100 Consequently, for each class, the mean annual change was estimated with 95% confidence intervals (CIs). Changes were considered significant if the 95% CIs for the percentage difference did not cross zero.