Skoog G, Cars O, Sk

1
POINT PREVALENCE STUDIES (PPS) OF ANTIMICROBIAL
USE IN SWEDISH HOSPITALS, 2003 AND 2004

• Skoog G, Cars O, Skärlund K, Elowson S, Hanberger
  H, Odenholt I, Prag M,
• Struwe J, Torell E, Ulleryd P, Erntell M.
• STRAMA, Swedish Institute for Infectious Disease
  Control, S-171 82 Solna, Sweden

Introduction and purpose Data revealing antibiotic consumption and prescription patterns related to diagnose at the patient level is essential in finding ways to optimize antibiotic use in the hospital setting. We present data from the first nation wide point prevalence studies, PPS, performed in Sweden. Methods The studies were performed within a two-week period in November 2003 and 2004 by the local STRAMA-groups using a web-based reporting system. Each department had one personal visit of an experienced doctor collecting data. The protocol was designed to present demographic data as well as the amounts and indications for antimicrobial agents against bacteria and fungi. Treatments were recorded in relation to diagnose and the therapeutic indication as either prophylactic use or treatment of community acquired and hospital acquired infection. 19 pre-defined diagnosis groups were used. Results Results from the 333 hospital departments participating in both PPS 2003 and 2004 are presented below. Distribution of therapy reasons in treated patients Antimicrobials in DDD/100 admitted adult patients in different specialities Number of admitted patients, 2003/2004, in brackets Distribution of antimicrobials for treatment and prophylaxis. Pooled data from both studies. Distribution of antimicrobials in treatment of community acquired pneumonia Distribution of antimicrobials in treatment of lower urinary tract infection in women Proportion of peri-operative prophylaxis prescribed for gt24 hours in some surgical specialitiesTotal number of therapies, 2003/2004, in brackets Conclusions The PPS method was successfully introduced and has been an important tool to identify problem areas of antimicrobial hospital treatments. Cephalosporins were over-used in community acquired infections as pneumonia and skin and soft tissue infections A large fraction of women with cystitis were treated with fluoroquinolones Peri-operative prophylaxis was too long, gt24 hours in over 40 of therapies
www.strama.se E-mail gunilla.skoog_at_smi.ki.se mats.erntell_at_lthalland.se
Abstract Background and Objective The objective
of the study was to introduce a nation wide
survey system for frequent assessment of the use
of antimicrobial agents in relation to diagnose.
Design Two PPS with one personal visit to each
department were performed within a two-week
period in November 2003 and 2004. The protocol
was designed to present demographic data as well
as the amounts and indications for antimicrobial
agents against bacteria and fungi. Treatments
were recorded in relation to diagnose and therapy
reason (community acquired (CAI) or hospital
acquired infection (HAI)). 19 pre-defined
diagnosis groups were used. Prophylactic use was
recorded in relation to prescribed doses. DDDs
were calculated according to the WHO standard. A
web-based reporting system was used to collect
the data. Setting Swedish hospitals, 31
different specialities. Main outcome measures
Antimicrobial use, in DDDs, in relation to
diagnose and therapy reason. Results The
departments participating in both studies
included 10 255 and 10 305 admitted patients
respectively. Correspondingly 31 and 32 of the
admitted patients were treated with
antimicrobials. Distribution of women/men and
adults/children were similar both years. The
numbers of therapies were 3377 (54 CAI, 27 HAI,
19 prophylaxis) and 3523 (52 CAI, 28 HAI, 20
prophylaxis) respectively. A large fraction of
women with cystitis were treated with
fluoroquinolones (20 resp. 24). The most common
indication for cephalosporins (DDD) was community
acquired pulmonary infections. Duration of
peri-operative prophylaxis was more than 24 hours
in about 40 of the cases. Conclusions
Demographic data from the two study periods were
congruent. Analysis of antimicrobial use in
relation to diagnose and therapy reason is an
important tool to identify problem areas.
Although the PPS method is time consuming, it was
successfully introduced resulting in one of the
largest surveys in Europe of antimicrobial
hospital treatment.
PPS 2003 2004
No. of admitted patients 10 255 10 305
No. of treated patients Distribution women / men Proportion children 3 212 (31) 49.5 / 50.5 5.6 3 314 (32) 49.8 / 50.2 5.2
No. of therapies 3 377 3 523
No of antibiotics 3 947 4 068
No. of DDDs 4 040 4 189
DDD/100 admitted 39.4 40.6
PPS 2003 2004
Community acquired 54 52
Hospital acquired 27 28
Prophylaxis 19 20
Diagnose groups Central nervous
system Ophthalmic infections Mouth and
throat Upper respiratory tract Bronchitis Pulmonar
y infections Cardiovascular system Upper
gastrointestinal tract Lower gastrointestinal
tract Infectious gastrointestinal
diseases Liver/bile duct/pancreas/spleen Skin and
soft tissue Bone and joint Lower urinary tract
infection Upper urinary tract infection Genital
infections Septicaemia, primary Un-specified
indication, fever Indication unclear