Hungarian Hospital Antibiotic Consumption at the Regional Level, 1996–2005 R. Benko, M. Matuz, P. Doro, R. Viola, E. Hajdu, D.L. Monnet, G. Soos Abstract Background: Regional variations in antibiotic consumption in outpatients have been reported previously, but nothing is as yet known about the regional distribution of antibiotic consumption in the hospital sector in Hungary. This study was designed to explore regional variations and investigate determinants of antibiotic consumption in hospital care in Hungary. Materials and Methods: Regional distribution-based anti- biotic sales data were obtained for a 10-year period (1996– 2005) for the 20 Hungarian counties. Systemic antibacterial use (Anatomical Therapeutic Chemical code: J01) was ex- pressed as the number of defined daily doses (DDD) per 100 patient-days. The multiple linear regression model was ap- plied to investigate the determinants of regional differences in hospital antibiotic consumption. Independent variables related to health care access, utilization of hospital re- sources, doctors’ workload, type of hospital care provided, and patient’s characteristics and infections were considered as possible determinants, and data on these variables were obtained for 2 years (2004, 2005). We also tested the association between hospital and ambulatory care antibiotic consumption in Hungarian regions using the Pearson corre- lation test. Results: For each year during the 1996–2005 study period, there were large and stable variations in total hospital antibiotic consumption (e.g., min–max 1996 : 16.0–28.2; min–max 2005 : 15.2–32.2 DDD per 100 patient-days) depending on the region. In the two developed models (Model 1 and Model 2), the number of reported infections accounted for 53% of the observed regional variations in hospital antibiotic consumption (Model 1), and the number of reported infections together with the case-mix index were responsible for 61% (Model 2) . Total antibiotic con- sumption in hospitals showed a positive correlation (R = 0.71, p = 0.002) with total antibiotic consumption in ambulatory care. Conclusion: The case-mix index and the number of re- ported infections explained some of the observed regional variations. However, the moderate value of the models in explaining these regional variations suggest that determi- nants which could not be explored in this preliminary study may also contribute to regional differences. Future studies should aim at collecting data for each individual hospital as well as data on possible determinants for hospital antibi- otic consumption. Infection 2009; 37: 133–137 DOI 10.1007/s15010-008-7468-6 Introduction The prevalence of antibiotic-resistant microorganisms is generally higher in hospitals than in the community [1]. In addition to non-compliance with infection control pre- cautions by hospital healthcare personnel, one obvious explanation is the frequent prescription of antibiotics to hospitalized patients [2–4]. An international network, the European Surveillance of Antimicrobial Consumption (ESAC, http://www.ua.ac.be/ESAC), has attempted to collect reliable data on both ambulatory and hospital antibiotic consumption in European countries. Hungary participates in this network and on the basis of hospital antibiotic consumption data reported for 2002, it has one of the lowest hospital antibiotic use in Europe [5]. Re- gional variations in hospital antibiotic consumption have been investigated in a number of countries, such as Ger- many and Norway [6, 7]. In a previous paper, we reported regional variations in antibiotic consumption in Hungar- ian ambulatory care [8]. The study reported here was R. Benko (corresponding author), M. Matuz, P. Doro, R. Viola, G. Soos Dept. of Clinical Pharmacy, University of Szeged, Szikra u. 8, 6725, Szeged, Hungary; Phone: (+36/62) 5449-44, Fax: -21, e-mail: benko@clph.szote.u-szeged.hu E. Hajdu Dept. of Clinical Microbiology, University of Szeged, Szeged, Hungary D.L. Monnet National Center for Antimicrobials and Infection Control, Statens Serum Institute, Copenhagen, Denmark (present address) Scientific Advice Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden Received: December 10, 2007 Æ Revision accepted: August 6, 2008 Published online: January 23, 2009 Infection Clinical and Epidemiological Study Infection 37 Æ 2009 Æ No. 2 Ó URBAN &VOGEL 133