Transcript Bild 1 - Snowfall

Changes in patterns of antimicrobial use in
Swedish hospitals 2003 to 2006 following
the introduction of large-scale nation wide
point prevalence studies (PPS)
Erntell M, Skoog G, Cars O, Elowson S, Hanberger
H, Jorup C, Odenholt I, Prag M, Skärlund K, Struwe
J, Torell E, Ulleryd P
The Strama programme, Stockholm Sweden
Swedish Point Prevalence Studies
PPS 2003, 2004 and 2006
(For method, Skoog, ECCMID 2004)
•
•
•
•
No of hospitals
No of admitted pat
No of therapies
Therapies, total no
2003 2004 2006
54
49
64
13,536 11,348 17,113
4,396 3,841 6,012
14,249
PPS 2003 / 2004 / 2006
Therapyreasons
Admitted patients treated for (%):
2003 2004 2006
• Community acquired 17,0 18,0 18,7
• Hospital acquired
9,2 9,4
9,9
• Prophylaxis
6,3 6,5
6,3
• Total
32,5 33,9 34,9
Antibiotic ”pressure” PPS 2003 - 2006
DDD/100 admitted patients
• PPS 2003
• PPS 2004
• PPS 2006
40.3
43.1
43.3
• ESAC PPS 2006
47.6
(ECCMID 2007)
J0
1C
la
B-
in
l
25,0
s
hi
b
az
o
s
Per cent of total DDD
30,0
O
th
er
as
e
ox
tri
m
id
e
am
es
es
m
es
tiv
Pc
Pc
cli
n
cy
en
e
nc
os
Co
-
Li
ct
am
1E
E
ap
Te
tra
ar
b
iva
se
ns
er
e
as
pc
s
ne
s
m
no
lo
ec
tru
zo
ld
1A
A
C
1F
F
J0
J0
J0
H
id
a
Im
1D
Pc
+
J0
1X
D
R
J0
ds
p
Pc
-n
oa
oq
ui
yl-
in
e
or
xa
zo
l
lo
sp
Is
o
Fl
uo
r
Br
E
A
1C
1C
J0
J0
A
F
ep
ha
1C
C
J0
1D
J0
1M
J0
Relative distribution of antibiotics in treatment of
community acquired infections, PPS 2003 and 2006
2003
2006
20,0
15,0
10,0
5,0
0,0
Areas for intervention before PPS 2006
Leaflet to all specialists and information:
• Length of peri-operative prophylaxis
• Community acquired pneumonia
• Reduction of Fluoroquinolones in
community acquired cystitis in women
PPS 2003 – 2006
Length of perioperative
prophylaxis in colo-rectal
PPS 2003 - 2006
Längd av peroperativ profylax vid colo-rectal kirurgi, riket, procentuell fördelning
surgery
90,0
80,0
70,0
Per cent
60,0
50,0
40,0
30,0
20,0
10,0
0,0
2003, N 69
Prophylaxis one dose
2004, N 43
Prophylaxis one day
2006, N 47
Prophylaxis >1 day
Treatment for community acquired pneumonia at
Depts.
Patterns of treatment of community acquired pneumonia at Dept of Internal medicin
of Internal medicine,
PPS
2003+2004
PPS 2003-2004
compared
to PPS 2006compared to PPS
2006
40,0
35,0
25,0
20,0
15,0
10,0
5,0
2003+2004, 854 DDD
2006, 667 DDD
Fl
A
J0
1M
O
th
er
s
uo
ro
qu
in
ol
on
es
id
es
Li
nc
os
am
M
J0
1F
A
J0
1F
F
ac
ro
lid
es
es
C
ar
ba
pe
n
em
es
Ce
ph
al
os
po
r in
J0
1D
B
-E
Na
r ro
w
J0
1C
E
J0
1D
H
c
sp
ec
tr
P
c
sp
ec
tr
P
Br
oa
d
J0
1C
A
Te
tra
cy
cl
in
es
0,0
J0
1A
A
Per cent of total DDDs
30,0
Treatment of community
acquired cystitis in women
PPS 2003 - 2006
Treatment of
community
acquired
in women
PPS
2003
- cystitis
2006
50,0
45,0
40,0
Per cent of therapies
35,0
30,0
25,0
20,0
15,0
10,0
5,0
0,0
J01CA Broad
spectrum Pc
J01DB First gen
cephalosporines
J01DC Second
gen
cephalosporines
J01EA
Trimethoprim
2003, No 151
J01EE Cotrimoxazole
2004, No 163
J01MA
Fluoroquinolones
2006, No 215
J01XE Nitrofuran
derivatives
Others
45,0
Hospital acquired infections (HAI), comparison between
the PPS 2003 and 2006 of the different types
40,0
35,0
Per cent of all HAI
30,0
25,0
20,0
15,0
10,0
5,0
0,0
Postoperative infections
Other device related
infections
C. difficile enterocolitis
PPS 2003 1 239
PPS 2006 1 813
Other HAI
HAI from other hospitals
Conclusions
The PPS method has become a valuable tool to describe
the antibiotic use in relation to diagnose
• We have observed:
– shorter courses of peri-operative prophylaxis
– Less fluoroquinolones in treatment of community
acquired cystitis in women
– No changes in treatment of CAP – more than
35 % of all treatments included cephalosporins
Swedish strategic programme
against antibiotic resistance