Gentamicin and antibiotic use in Norwegian hospitals: a study from 35 point-prevalence surveys, 2015 to 2023

BACKGROUNDInappropriate and excessive use of broad-spectrum antibiotics drives antimicrobial resistance. Gentamicin, an Access antibiotic in the WHO AWaRe framework with low resistance potential, has long been recommended in Norway for empirical treatment of serious infections. However, real-world data on aminoglycoside use remain limited.AIMWe aimed to describe gentamicin and overall antibiotic use in Norway, including COVID-19 pandemic-related changes, and report the extent of gentamicin use across selected indications.METHODSData were obtained from patients ≥ 20 years from 35 national point-prevalence surveys (2015-2023) across 68 Norwegian hospitals.RESULTSAmong 241,546 hospitalised patients, 66,586 received antibiotics (yearly prevalence 26.9-28.1%), with the highest proportions in the 70-79 (26.4%) and ≥ 80 (23.4%) years age groups. Aminoglycosides, mainly gentamicin, ranked ninth among all antibiotic prescriptions. From 2021, third-generation cephalosporins (13-14%) surpassed β-lactamase-sensitive penicillins (12-13%). Gentamicin use increased from 4.1% in 2015 to 5.8% in 2023, mainly in combination with ampicillin, benzylpenicillin, or ampicillin plus metronidazole. Main indications were urinary tract, lower respiratory tract and intraabdominal infections, and sepsis. An increasing pre-COVID-19 pandemic trend in gentamicin use (β₁: 0.105; p < 0.001) was no longer observed after the COVID-19 outbreak was declared a global pandemic on the 11 March 2020 (β₃:  - 0.112; p = 0.013).CONCLUSIONGentamicin use among hospitalised patients in Norway remains low but appears higher than in other European countries. Increases in gentamicin use pre-COVID-19 pandemic were no longer observed after COVID-19, supporting the need for surveillance and antibiotic stewardship to minimise unnecessary use of broad-spectrum antibiotics.