POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN HOSPITALISED PEDIATRIC PATIENTS IN SWEDEN

1. POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN HOSPITALISED PEDIATRIC PATIENTS IN SWEDEN Abstract 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. 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. Children were identified as patients 0-16 years old. Results: 28 out of the 54 participating hospitals in the main study recorded data for children. Four pediatric departments at university hospitals included nearly 50% of the patients. 266 children (125 girls, 141 boys) were treated with antimicrobial agents and 27 of them were admitted to wards for adults. The children were given 279 different therapies and 29% of these were related to immunosuppression and foreign material or both. In departments of pediatrics 252 (28%) patients were treated with antimicrobials. The distribution of the 279 therapies was; community acquired infections in 52%, hospital-acquired infections in 23% and prophylaxis in 25%. The most common diagnose groups were; primary septicaemia 47 (17%), pulmonary infections 42 (15%), upper urinary tract infection 26 (9%), lower gastrointestinal tract 25 (9%) and skin and soft tissue infections 24 (9%). 340 different antimicrobials were used, 258 for treatment and 82 for prophylaxis. The most commonly used antimicrobials were: in treatment, cephalosporins 106 (41%), beta-lactamase sensitive penicillins 22 (9 %), tienamycins 19 (7%), glycopeptides 17 (7%). In prophylaxis, the order of use was cephalosporins 25 (30%), co-trimoxazole 13 (16%), beta-lactamase resistant penicillins 12 (15%) and beta-lactamase sensitive penicillins 6 (7%). More than 90% of treatments were assessed as adequate. The length of prophylaxis was too long, more than one day, in nearly 50% of al perioperative prophylactic treatments. Conclusions: The PPS method was successfully introduced resulting in one of the largest surveys in Europe of antimicrobial hospital treatments in children. The study indicates that hospitalised children in Sweden are treated for serious infections. But still, the use of cephalosporins is too predominating. Perioperative prophylaxis is too long, as in adults. The therapy reason for treatment was: CAI in 52%, 14% of all admitted HAI in 23%, 7% of all admitted Prophylaxis in 25%, 7% of all admitted Antimicrobials used in 82 therapies as prophylaxis (%): peri-operative (49) medical (33) Cephalosporins 49 12 Isoxa-pc 22 3 Nitroimidazoles 12 3 Beta-lact sens pc 4 12 Co-trimoxazole 2 36 Trimetoprim 2 12 Erntell M, Skoog G, Cars O, Eriksson M, Skärlund K, Elowson S, Hanberger H, Odenholt I, Prag M, Struwe J, Torell E, Ulleryd P. STRAMA, Swedish Institute for Infectious Disease Control, S-171 82 Solna, Sweden Diagnose groups 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