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Study of ten hospitals in Baden-Württemberg / Need for optimization in antibiotic selection, infection diagnostics and therapy documentation / Wide availability of infectious disease specialists and structured antibiotic programs required

A study published on November 14, 2024 by the Medical Center - University of Freiburg shows clear deficits in the prescription of antibiotics in non-university hospitals in Germany. In 2021, over 8,500 patients were examined in ten hospitals of different sizes, which account for 10 percent of hospital beds in Baden-Württemberg. One key finding: antibiotic prescriptions often do not meet the recommended quality standards. The study appeared in the specialist journal Eurosurveillance and was published shortly before World Antibiotic Awareness Week (WAAW), which the World Health Organization (WHO) is holding from 18 to 24 November to draw attention to the global problem of antibiotic resistance.

"Our results highlight the urgent need for sustainable antibiotic programs and infectious disease specialists to improve patient care," says study leader Prof. Dr. Siegbert Rieg, Head of the Department of Infectious Diseases at the Department of Medicine II of the Medical Center - University of Freiburg. "This is the only way we can prevent resistance in the long term and improve the quality of treatment."

Major differences in the quality of care

Around a third of the patients examined received at least one antibiotic, mostly for treatment, in rarer cases for prevention. Overall, there was a wide variation in the quality of prescriptions, but a quarter of all prescriptions were inadequate, and around half of the patients could have been treated with an antibiotic with a narrower spectrum of activity. Other quality indicators such as the timely documentation of the duration of treatment or the review of antibiotic therapy after 2-3 days were only met in around a third of cases. The switch from intravenous to oral antibiotics also only took place in around half of the patients for whom this would actually have made sense.

It is also critical that a blood culture analysis was only carried out in 45 percent of cases and sufficient microbiological samples were taken from around 60 percent of patients before starting antibiotic therapy, although these tests provide essential information for therapy management. "In addition to antibiotic selection in need of optimization, a lack of diagnostics and inadequate documentation significantly impair the quality of care. These deficits not only jeopardize the effectiveness of treatment, but also contribute to the development of resistance," emphasizes Rieg.

Structured programs urgently needed

The study highlights the need for structured programs that ensure the proper prescription and use of antibiotics. "Such antimicrobial stewardship programs could make a significant contribution to reducing unnecessary antibiotic therapies and increasing the quality of treatments," explains Rieg. However, most non-university hospitals currently lack such programmes and specialized staff in the form of specialists in internal medicine and infectiology.

"With the knowledge that has been built up at our clinic for more than 15 years on antibiotic stewardship and the infectiology consultation service, we can offer other hospitals important support. Our findings show that this is necessary," says Prof. Dr. Robert Thimme, Medical Director of the Department of Medicine II at the Medical Center - University of Freiburg.

Future steps

"The widespread use of antimicrobial stewardship and the broad availability of specialized infectiologists are crucial measures to improve the quality of care. Germany has some catching up to do here," says Rieg. Further investigations as part of the ID roll-out study will now show exactly how the introduction of AMS programs should be structured and how many specialized personnel are required to achieve the greatest possible effect on the quality of antibiotic therapy in non-university hospitals. The study was carried out as a cooperative project by the Department of Infectiology, Clinic for Internal Medicine II, and the Section for Health Services Research and Rehabilitation Research (SEVERA) at the Medical Center - University of Freiburg as well as the AOK Baden-Württemberg and ten non-university hospitals. Funding was provided as part of the GBA Innovation Fund's call for proposals in the project 'ID (Infectious Diseases) ROLL OUT - Infectiology consultation and advisory activities in combination with antibiotic stewardship activities in non-university hospitals'.

Original title of the publication: An in-depth analysis of antimicrobial prescription quality in 10 non-university hospitals, in southwest Germany, 2021.
Link to the study: Eurosurveillance | An in-depth analysis of antimicrobial prescription quality in 10 non-university hospitals, in southwest Germany, 2021