France is a major consumer of antibiotics ranking 4th in the European hospital environment according to the latest data available, and 5th for community use. A recent press release from the French National Authority for Health (HAS) shows that, despite a programme initiated in 2011 to achieve a 25% reduction in antibiotic use by 2016, medical use is rising again in 2014, meaning France has an antibiotic consumption 30% higher than the European average. However, its figures for antibiotic resistance ‘are good compared with those from most European countries but, however, significantly poorer than those of Scandinavian countries’ Professor Berthelot points out.
So what measures have been put to use to control the spread of drug-resistant bacteria in the hospital environment? All French hospitals have a medical committee to deal with nosocomial infections and antibiotic use, respectively named Comité de Lutte contre les Infections Nosocomiales (CLIN) and Comité des Anti-infectieux. These now almost always include, as part of the team, an infection control practitioner. However, the background training profile of the infection control practitioner in France varies explains Professor Berthelot. ‘To become an infection control practitioner a doctor can come from a background in microbiology, infectious diseases, Public Health, pharmacy, or clinical care.’ This type of multiple training allows the infection control practitioner to work in more than one department, as Professor Berthelot does. He is part of the hospital’s Infectious Disease Department and also part of the Microbiology Laboratory, which allows him a ‘transversal view of hospital infections’.
Hospitals develop protocols based on recommendations drawn up by one of the major national bodies in infection control, such as the French Society for Hospital Hygiene (SF2H), French Society of Infectious Diseases (SPILF), French Society of Microbiology (SFM) or those outlined by the HAS. However, individual hospitals are free to adapt the recommendations for best use in their particular establishment.
One way these recommendations have been proved effective in reducing infection is in the preventive use of antibiotics before surgery. Professor Berthelot explains that, ‘working in conjunction with the surgical team providing prophylactic antibiotics guided by the microbiology laboratory, and with reinforced hygiene measures, has seen a substantial decrease in nosocomial infections in surgical patients over the past five years.
‘Additionally,’ he added, ‘measures that isolate patients who are already known, or recently identified as carriers of resistant organisms, although seemingly onerous and expensive have been shown to be highly effective in reducing the transmission of resistance.’
Some hospitals are also creating the role of ‘antibacterial therapy expert’, often a medical practitioner, who has a clear idea of the epidemiology of infections and the correct use of antibiotics.
In the absence of such experts in every hospital, there are guidelines for the prudent use of antibiotics that demand that the situation should be re-evaluated two to three days after the initial prescription, in order to confirm a response to the treatment and prevent the emergence of resistance.
A change in antibiotic is recommended if there is any sign of resistance to the first-line treatment, which should be as targeted as soon as possible. It is of course, Professor Berthelot emphasises, ‘extremely important that sufficient antibiotic is given for the correct length of time to achieve complete eradication of the infection’.
However, one thing we should remember he points out: ‘antibiotics have saved and continue to save millions of lives, with few new molecules on the horizon it is our duty to ensure they remain able to do so, we must use them wisely.’
Professor Philippe Berthelot, an Infection Control Practitioner at the University Hospital of Saint-Etienne, is also president of the French Society for Hospital Hygiene (SF2H).