Antibiotic use in different hospital administrative categories: an overview of 10 years of a statewide surveillance program in Brazil.

Objective: The present study aimed to describe ICU antibiotic use based on data reported from 2009 to 2018 to the Nosocomial Surveillance System (NSS) of the State Health Department in the State of Sao Paulo, Brazil. Design: Ecological study. Setting: Data obtained from hospitals located in the state of São Paulo, Brazil from 2009 to 2018. Participants: Intensive care units located at participant hospitals. Methods: Data on healthcare-associated infections, antibiotic usage, and bacterial identification were collected and reported monthly by hospitals. Antibiotic consumption was quantified as defined daily doses (DDD) per 1000 patient-days. The relationship between antibiotic use and bacterial resistance, categorized by hospital type and ICU complexity, was analyzed using statistical methods to assess correlations and significance. Results: Our findings reveal an escalating trend in antibiotic consumption over the study period, with a notable increase from 588.16 DDD per 1000 patient-days in the initial year to 943.12 DDD/1000 patient-days in the final year (p < 0.01). Cephalosporins emerged as the most frequently utilized class, accounting for 33.9% of total antibiotic consumption. Public hospitals exhibited significantly higher antibiotic use compared to private and philanthropic institutions, with a mean of 889.11 DDD/1000 patient-days in public hospitals compared to 849.07 DDD/1000 patient-days in private hospitals and 785.12 DDD/1000 patient-days in philanthropic hospitals (p < 0.05). Conclusions: The study provides critical insights into antibiotic use and resistance in different hospital settings, emphasizing the importance of tailored antimicrobial stewardship strategies.