P1186 POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN SWEDISH HOSPITALS

1. P1186POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN SWEDISH HOSPITALS Abstract 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. 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. 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%), beta-lactamase 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. 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. 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 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