TY - JOUR T1 - The Belgian policy of funding antimicrobial stewardship in hospitals and trends of selected quality indicators for antimicrobial use, 1999-2010: a longitudinal study. JF - BMJ Open Y1 - 2015 A1 - Marie-Laurence Lambert A1 - Bruyndonckx, Robin A1 - Goossens, Herman A1 - Hens, Niel A1 - Aerts, Marc A1 - Boudewijn Catry A1 - Neely, Fiona A1 - Vogelaers, Dirk A1 - Hammami, Naïma KW - Anti-Bacterial Agents KW - Belgium KW - Cefazolin KW - Female KW - Financing, Government KW - Hospital Costs KW - Hospitalization KW - hospitals KW - Humans KW - Longitudinal Studies KW - Lower Extremity KW - Male KW - Orthopedic Procedures KW - Pneumonia KW - POLICY KW - Postoperative Complications KW - Quality Indicators, Health Care KW - Risk Adjustment AB -

OBJECTIVES: In order to improve antimicrobial (AM) use, a policy of providing technical and financial support to AM management teams (AMTs) was rolled out in all Belgian hospitals between 2002 and 2008. We aimed to analyse the association of this policy with AM use for the two indications accounting for the largest number of patients receiving AM: prophylaxis for major lower limb orthopaedic surgery and pneumonia.

DESIGN, SETTING, PARTICIPANTS: We used patient-level data routinely collected in all Belgian acute care hospitals between 1999 and 2010. We modelled trends for selected quality indicators (QIs) using the year of AMT implementation in each hospital as the main 'change point', with fine-tuned case-mix adjustment. Of all admissions for lower limb orthopaedic surgery, and pneumonia between 1999 and 2010, 90% (325 094) and 95% (327 635), respectively, were found eligible for analyses.

OUTCOMES: The surgery QI was defined as: cefazolin, dose in the expected range, and no use of other AM. For pneumonia, QIs were: ratio of oral/parenteral defined daily doses (DDD, O/P QI), and mean number of DDD minus penicillin, per 100 days of hospitalisation (DDD QI).

RESULTS: Between 1999 and 2010, the surgery QI improved from 59% to 71%, the O/P QI from 0.72 to 0.97, and the DDD QI from 96 to 64. Heterogeneity between hospitals was high. Overall, no association was found with the year of implementation of the AMT.

CONCLUSIONS: Improvements have been observed but could not be related at the national level to the policy under study. However, these results cannot be extrapolated to other QIs for AM use in hospitals. Our findings do not question the need for AMT, nor the need for continuation of AMT funding. Several recommendations can be made in order to make the best of Belgium's unique political and financial commitments in that field.

VL - 5 CP - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25681314?dopt=Abstract M3 - 10.1136/bmjopen-2014-006916 ER -