Antimicrobial use in Spanish hospitals (EPINE, 1990-1999)

Background: Monitoring of antimicrobial use and knowledge of prescription habits are some of the strategies recommended to contain the resistance to antimicrobials in hospitals. Method: We analyzed a series of 10 annual studies of prevalence during the period 1990-1999 (EPINE project) in Spanish hospitals. Estimates of antimicrobial use were calculated as the percent distribution of every antimicrobial related to the overall antimicrobials prescribed. Results: Among 484,013 hospitalized patients, 34 to 36% were receiving antimicrobials (antibiotics > 90%). Amoxicillin-clavulanate use increased from 3.8% in 1990 up to 14.8% in 1999 (P < 0.01). Significant increases were also observed in the use of carbapenems (0.9 to 2.7%; P < 0001), glycopeptides (1.7 to 3.7%; P < 0.01) and quinolones (8.5 to 11.3%; P < 0.01) though a lesser degree. Conversely, the use of aminoglycosides decreased over the decade studied (15.8 to 9.4%; P < 0.01). Conclusions: Even though use of antimicrobials has increased over the last decade, current figures are within the ranges observed in other countries. The pattern of antibiotics use has changed during this period: while the use of aminoglycosides decreased, that of beta-lactams plus beta-lactamase inhibitors, quinolones and carbapenems increased.