Broad-spectrum and Watch antimicrobials are commonly used to treat hospital-acquired infections in German acute care hospitals: results from the 2022 national point prevalence survey

BackgroundHospital-acquired infections (HI) and associated antimicrobial use (AU) significantly contribute to antimicrobial resistance. We aimed to analyse AU patterns for HI treatment in German acute care hospitals.MethodsWe analysed data from the German 2022 point prevalence survey (PPS) on AU and healthcare-associated infections, using the European Centre for Disease Prevention and Control protocol across 252 hospitals. Analyses focused on key infection prevention and control (IPC), antimicrobial stewardship (AMS) indicators and AU for HI, categorised by the World Health Organisation AWaRe classification. Comparisons were made to the previous national PPS in 2016 and 2011.ResultsA total of 22 422 antimicrobial prescriptions were recorded in 66 586 patients. HI treatment accounted for 20% of AU. Penicillins with beta-lactamase inhibitors, carbapenems and third-generation cephalosporins accounted for over 50% of AU for HI treatment. Watch antimicrobials dominated HI treatment prescriptions, accounting for around 62% of use, particularly in respiratory infections, while use of Access antimicrobials was limited (24%). Skin and soft tissue as well as bone and joint infections, respiratory infections, and urinary tract infections were the most commonly treated HI. Over time, IPC indicators, such as alcohol-based hand rub consumption and IPC staffing, improved significantly, yet AMS staffing remained low and comprehensive hospital-wide post-prescription reviews were limited to around a quarter of hospitals.ConclusionsThe findings underscore the importance of reducing HI to curb the use of broad-spectrum antimicrobials in German hospitals. IPC should be included in AMS strategies, alongside aspects like improving AMS staffing and establishing post-prescription review programmes.