Transcript Smittskyddsinstitutet/Stefan Zimmerman

P1186
POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN SWEDISH HOSPITALS
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
3 000
Number of therapies
60
40
Urology 40
Orthopaedics 212
ENT surgery 15
Prophylaxis single dose
General surgery
202
Gynaecology 48
Other surgery 65
Proportion of DDD (%)
35
90% of treatments were adequate (60%
empirical treatment and 30% directed by
cultures). Less than 2% of treatments were
assessed as completely wrong. Eight percent
were considered incorrect in some way; too
high dose, lack of indication or use of too
broad spectrum drugs.
30
25
20
15
10
Isoniazid
Ethambutol
Rifampicin
Caspofungin
Amphotericin B
Triazole derivatives
Monobactams
Linezolid
Fusidic acid
Vancomycin po
Nitrofurantoin
Aminoglycosides
Glycopeptides
Combinations of pc
Trimethoprim and sulfonamides
Trimethoprim
Nitromidazole derivate po
Imidazole derivatives iv
Lincosamides
Carbapenems
Tetracyclines
Beta-lactamase sensitive pc
Broadspectrum pc
Fluoroquinolones
Isoxazolyl-pc
Cephalosporins
Macrolides
Proportion of prophylaxis
Proportion of all therapies
(%)
For children the corresponding results in
number of therapies were; cephalosporins
(42% and 31%), beta-lactamase sensitive
penicillins (8 % and 8%), carbapenems (8% and
1%), glycopeptides (7% and 0%), and cotrimoxazole (6% and 15%). The number of
therapies was 39.9/100 admitted children.
Paediatric rehab.
Neuro rehab.
Hand surgery
Endocrinology
Plastic surgery
Vascular surgery
Dermatology
Ophtalmology
Neurosurgery
Paediatric surgery
Neonatal dept.
Gastroenterology
Transplantation surgery
Nephrology
Rheumatology
Haematology
Thoracic surgery
Lung medicine
Urology
Emergency dept.
Cardiology
ENT
Neurology
Oncology
Maternity/obstetric dept.
Rehab. Medicine
Gynaecology
Infectious diseases
Antimicrobials in DDD per 100 admitted patients in adult specialities
DDD/100 admitted patients
Number of admitted patients
DDD
Community acquired infection (CAI)
Hospital acquired infection (HAI)
Community acquired infection (CAI)
Hospital acquired infection (HAI)
Infectious GI disease
Upper respiratory tract
Mouth and throat
CNS
Cardiovascular system
Indication unclear
Bronchitis
Genital infections
Un-specified indic.
Septicaemia, primary
Upper GI tract
Bone and joint
Liver/bile/pancreas/spleen
Skin and soft tissue
Lower GI tract
Pulmonary infections
Lower urinary tract
Upper urinary tract
Ophthalmic infections
Infectious GI disease
Cardiovascular system
Upper respiratory tract
Indication unclear
Mouth and throat
Genital infections
0
Liver/bile/pancreas/spleen
Ophthalmolgy
Hand surgery
Maternity/obstetric dept.
Neurology
Cardiology
Rehab. medicine
Neuro rehab.
Geriatrics
Gynaecology
Rheumatology
Nephrology
Internal medicine
Dermatology
ENT
Oncology
Emergency dept.
Orthopaedic surgery
General surgery
Gastroenterology
Lung medicine
Neurosurgery
Urology
Plastic surgery
Endocrinology
-
0
Lower urinary tract
500
20
CNS
20
50
Bronchitis
1 000
Upper GI tract
40
40
Bone and joint
1 500
60
100
Septicaemia, primary
60
80
150
Un-specified indic.
2 000
100
Upper urinary tract
80
200
Lower GI tract
2 500
120
Skin and soft tissue
100
Fluoroquinolones (J01MA) in DDD per diagnose group
250
Pulmonary infections
3 000
DDD
120
3 500
Number of admitted patients
Cephalosporins (J01DA) in DDD per diagnose group
60
50
40
30
20
10
0
Empirical therapy
Dose not correct
Drug not correct
Other mistakes
Conclusions
Analysis of treatment of different diagnoses
shows over-use of cephalosporins in
community acquired pneumonia and
fluoroquinolones in urinary tract infections.
-
70
Country University hospital County hospital Local hospital
1 000
500
80
Directed therapy
1 500
4 000
Prophylaxis >24 hours
Evaluation of given therapies (n=3907)
2 000
140
Prophylaxis 24 hours
40
Proportion of treatment
2 500
Paediatric medicine
80
0
0
Patients not treated with antimicrobials
Patients treated with antimicrobials
Thoracic surgery
E-mail: [email protected]
[email protected]
100
5
3 500
Transplantation surgery
The study was performed within a two-week
period in November 2003 by the local STRAMAgroups 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.
120
45
4 000
Geriatrics
Methods
All peri-operative prophylaxis in surgical departments
50
Distribution of admitted patients per speciality, treated and not treated with
antimicrobials
Orthopaedic surgery
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. This is the
first nation wide point prevalence study, PPS,
performed in Sweden.
Length of peri-operative prophylaxis was >1
day in 45% of all therapies for this indication.
20
54 hospitals participated in the study. 4,178 patients
treated with antimicrobial agents were included out
of 13,536 admitted. 31% of the admitted patients
were treated with antimicrobials. 4,395 therapies were
recorded. 266 (6.4%) were given to children (<17
years) and 49.9% to women. The indication for
treatment was CAI in 17%, HAI in 9% and
prophylaxis in 6%.
For adults cultures were taken before oral treatment
in 60% and before parenteral treatment in 69%.
Haematology
Introduction and purpose
Central nervous system
Ophthalmic infections
Mouth and throat
Upper respiratory tract
Bronchitis
Pulmonary 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
Results
General surgery
Conlusions: The PPS method was successfully introduced resulting in one of the largest surveys
in Europe of antimicrobial hospital treatment. The study describes suboptimal prescription patterns
for certain diagnoses.
The most commonly used antimicrobials for
adults expressed in DDD in treatment and in
prophylaxis were cephalosporins (23% and
18%), isoxazolyl-pc (13% and 47%),
fluoroquinolones (12% and 9%) and
broadspectrum pc (10% and 4%). The total
amount of antimicrobials used for adults was
40.3 DDD/100 admitted patients.
Diagnose groups
Antimicrobials in proportion of DDD in treatment and prophylaxis for adults
Vascular surgery
Results: 54 hospitals participated in the study. 4,178 patients treated with antimicrobial agents
were included out of 13,536 admitted to nine university hospitals (1,538 treated patients), 20
county hospitals (1,855 patients), and 25 local hospitals (785 patients). 31% of the admitted
patients were treated with antimicrobials. 4,395 treatments were recorded. 266 (6.4%) were given
to children (<17 years) and 49.9% to women. The indication for treatment was CAI in 17%, HAI in
9% and prophylaxis in 6%. For adults cultures were taken before oral treatment in 60% and before
parenteral treatment in 69%. The most commonly used antimicrobials for adults, expressed in
DDD, in treatment and in prophylaxis were cephalosporins (23% and 18%), isoxazolyl-pc (13%
and 47%), fluoroquinolones (12% and 9%), broadspectrum-pc (10% and 4%). The total amount of
antimicrobials used for adults was 40.3 DDD/100 admitted patients. For children the
corresponding results in number of treatments were; cephalosporins (42% and 31%), betalactamase sensitive penicillins (8 % and 8%), tienamycins (8% and 1%), glycopeptides (7% and
0%), and co-trimoxazole (6% and 15%). The number of treatments was 39.9/100 admitted
children. Analysis of different diagnoses shows over-use of cephalosporins in community acquired
pneumonia and fluoroquinolones in urinary tract infections.
Internal medicine
Method: A nation wide PPS with one personal visit to each department was performed within a
two-week period in November 2003. 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 diagnoses and prophylactic use, community acquired
(CAI) and hospital acquired infection (HAI). 19 pre-defined diagnosis groups were used.
Infectious diseases
Objectives: 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. The STRAMA-groups have
performed the first point prevalence study, PPS, using a web-based reporting system.
Number of patients
Large-scale nation wide point prevalence study of indications for antibiotic use in 54
Swedish hospitals 2003
Skoog G, Cars O, Skärlund K, Elowson S, Hanberger H, Odenholt I, Prag M, Struwe J, Torell E,
Ulleryd P, Erntell M. The STRAMA-programme (The Swedish Strategic Programme for the
Rational use of Antimicrobial agents), Stockholm, Sweden.
Treatments were recorded
in relation to diagnose and
the therapeutic indication as
either prophylactic use or
treatment of community
acquired (CAI) and hospital
acquired infection (HAI). 19
pre-defined diagnosis groups
were used.
DDD/100 admitted patients
Abstract
The PPS method was successfully introduced
resulting in one of the largest surveys in
Europe.
• 90% of treatments were adequate
• Peri-operative prophylaxis was too long,
more than 1 day in 45% of therapies
• The HAI prevalens was 9%
• Cephalosporins are over-used in community
acquired infections as pneumonia and skin
and soft tissue infections
• Fluoroquinolone use is too high in urinary
tract infections