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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