Transcript Smittskyddsinstitutet/Stefan Zimmerman

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
Design: Two PPS with one personal visit to each department were performed within a twoweek 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.
Results from the 333 hospital departments
participating in both PPS 2003 and 2004 are
presented below.
PPS
2003
2004
No. of admitted
patients
No. of treated patients
10 255
10 305
•Distribution women / men
•Proportion children
No. of therapies
No of antibiotics
No. of DDD´s
DDD/100 admitted
35%
30%
PPS 2003
25%
PPS 2004
20%
15%
10%
5%
3 212 (31%)
3 314 (32%)
49.5 / 50.5%
5.6%
49.8 / 50.2%
5.2%
3 377
3 947
4 040
39.4
3 523
4 068
4 189
40.6
0%
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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.
Proportion DDD
Abstract
Distribution of antimicrobials in
treatment of community acquired
pneumonia
Results
Distribution of antimicrobials in
treatment of lower urinary tract infection
in women
50%
45%
Introduction and purpose
E-mail: [email protected]
Proportion DDD
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Proportion of peri-operative prophylaxis
prescribed for >24 hours in some surgical
specialities
Number of admitted patients, 2003/2004, in brackets
90%
140
120
80%
Total number of therapies, 2003/2004, in brackets
70%
PPS 2003
PPS 2003
PPS 2004
PPS 2004
100
80
60
40
50%
40%
30%
10%
-
Distribution of antimicrobials for treatment
and prophylaxis. Pooled data from both studies.
45%
Proportion DDD
60%
20%
20
50%
www.strama.se
5%
Antimicrobials in DDD/100 admitted adult
patients in different specialities
Diagnose groups
40%
Treatment
35%
Prophylaxis
30%
25%
0%
Urology
(33/39)
Thoracic
surgery
(27/25)
General
surgery
(121/135)
ENT surgery
(16/15)
Orthopaedics
163/155)
Gynaecology All specialities
(19/35)
(471/484)
Conclusions
The PPS method was successfully introduced
and has been an important tool to identify
problem areas of antimicrobial hospital
treatments.
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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
10%
ed
,
52%
28%
20%
15%
or
54%
27%
19%
20%
nd
Community acquired
Hospital acquired
Prophylaxis
25%
ex
te
2004
PPS 2004
30%
Pc
2003
PPS 2003
35%
Proportion therapies
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.
PPS
In
Tr fec
an tio
sp us
la d i
n t se
at a
i o se
H n s s (5
ae ur 3
H ma ger 0/5
a n to y 0
E
Th n d s log (45 3)
or do ur y ( /40
ac cr ge 91 )
ic in ry /9
Pl su olo (19 0)
Lu ast rge gy /1
ng ic ry (33 5)
m sur (11 /26
ed ge 0 )
ic ry /14
in
G
U
en
ro e ( (18 0)
lo 13 /2
er
g
9
al
O
rth G s E y (1 2/1 )
op as urg NT 61 35
ae tro er (1 /1 )
di en y ( 87 75
c
1
)
su ter 65 /13
o
Em N rge log 4/1 6)
7
er eur ry ( y ( 15
7
g e os 1 2 1 )
nc ur 93 /79
y ge /1 )
O de ry 27
In
n p ( 6
te
rn D col t. (1 41/ )
al er og 9 41
m ma y ( 7/1 )
ed to 1 9
ic lo 85 7)
i
/
N ne gy ( 149
R ep (2 27 )
h h 8
Va eu ro 34 /35
sc ma log /28 )
ul to y ( 68
a lo 8 )
R
eh Ne r su gy 4/8
ab ur rg (7 8)
. m olo er 9/8
e g y( 8
C dic y (2 30/ )
a r in 0 3 8
di e 4 )
o
( /1
G
M
er logy 187 96
G
)
at
yn ia
er
tri (19 /17
a
ni O ec cs 6 4)
ty ph o ( /1
/o t lo 56 6
bs ha gy 0 6)
te lm (3 /5
tri o 9 35
c lo 6/ )
de gy 47
pt (3 7)
.( 5
18 /3
8/ 3)
24
8)
Methods
Distribution of therapy reasons in treated
patients
DDD/100 admitted patients
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.
40%
•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, >24
hours in over 40% of therapies