Transcript Smittskyddsinstitutet/Stefan Zimmerman

POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN
HOSPITALISED PEDIATRIC PATIENTS IN SWEDEN
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
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.
2
4
6
8
10
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
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.
12
47 septicaemia therapies with 65 different antimicrobials in children
PPS 2003
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
Introduction and purpose
Cultures were taken before oral treatment in 68%
and before parenteral treatment in 73%.
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 on pediatric patients from the first
nation wide point prevalence study, PPS,
performed in Sweden.
The distribution of diagnosis groups and
therapy reasons in treated children:
PPS 2003
Children (0-16 y) - diagnose group and reason of therapy (279 therapies)
50
45
40
Number of therapies
Methods
The study was performed within a two-week
period in November 2003 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.
Diagnose groups
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. Children were
defined as patients 0-16 years old.
35
Medical prophylaxis
30
Perioperative prophylaxis
25
HAI
20
CAI
15
10
86% of all treatments were assessed as
adequate.
Un-specified inf
Enteric inf
Upper GI tract inf
Genital inf
Liver and bile inf
Lower urinary
tract inf
Fever
Vascular inf
Bronchitis
CNS
Upper airway inf
Bone and joint inf
Mouth and throut
Skin and soft
tissue inf
Lower GI tract inf
Upper urinary tract
inf
Septicaemia
0
Pneumonia
5
The antimicrobials used in 258 treatments for
CAI and HAI were:
Conclusions
PPS 2003
Children (0-16 y) - treatment for CAI and HAI (258 antimicrobials)
120
100
Number of therapies
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
80
60
40
Others
J02AA
Antifungas
J01FA Makrolides
J01FF
Linkosamides
J02AC Triazoles
J01XD Imidazoles
J01CA Broad
spectrum Pc
J01MA
Fluoroquinolones
J01EE Cotrimoxazoles
J01GB
Aminoglycosids
J01XA
Glycopeptids
J01DH
Carbapenems
J01CE Betalactamase sens
pc
J01DA
Cephalosporins
0
J01CF Isoxazolylpc
20
Antimicrobials used for treatment of three
community acquired infections (CAI):
PPS 2003
Antimicrobials used in three community acquired infections in children
Results
16
14
12
Number of therapies
28 out of 54 hospitals participating in the main
study recorded data on 913 admitted children.
Four pediatric departments at university
hospitals included nearly 50% of the patients.
10
8
6
4
2
Pneumonia, 23
Skin and soft tissue inf, 17
Upper urinary tract inf, 22
P01AB
Nitroimidazoles
J01GB
Aminoglycosides
J01MA
Fluoroquinolones
J01FF
Lincosamides
J01FA Macrolides
J01EE Cotrimoxazoles
J01DH
Carbapenemes
J01DF
Monobactames
J01DA
Cephalosporins
J01CF Isoxa-pc
J01CE Betalactamase sens
pc
0
E-mail: [email protected]
[email protected]
The length of peri-operative prophylaxis was
too long , >1 day, in 59% of all therapies.
The PPS method was successfully introduced
resulting in one of the largest surveys in
Europe of antimicrobial hospital treatments in
children.
• 86% of treatments were adequate
• Peri-operative prophylaxis was too long, >1
day in 59% of therapies
• The HAI prevalens was 7%
• Cephalosporins are over-used in community
acquired infections as pneumonia and skin and
soft tissue infections
• 29% of the therapies were complicated by
immunosuppression and/or foreign material
• Cultures were taken in 68% before oral
treatment and 73% before parenteral treatment
slagnufitnA
nilahpe coR
nilli camI
nilli careH
nilli ca v kE
t xim mirt caB
menoreM
maneiT
nilli cat koD
nilli cinepl y sneB
fe caniZ
o c ylgonimA
0
fni ni co cnaV
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 predefined diagnosis groups were used. Children were identified as patients 0-16 years old.
mutroF
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.
seipareht fo rebmuN
Abstract
Antimicrobials used in 47 septicaemia
treatments:
narofalC
266 included children (141 girls, 125 boys)
279 different therapies were recorded;
251 in departments of pediatrics (28%)
28 in wards for adults
29% were related to immunosuppression and
foreign material infections.