Transcript Smittskyddsinstitutet/Stefan Zimmerman

POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN
SWEDISH HOSPITALS - PROPHYLAXIS IN ADULTS
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
Results
Conlusions: Peri-operative surgical prophylaxis was too long, 44% was prescribed for more than 24 hours.
The percentage of antibiotics that was given as more than one dose varied between 32% and 89% with the
highest figure noted for prophylaxis in bone and joint surgery.
70%
60%
50%
40%
30%
20%
10%
(1
9
le
en
s/
sp
ct
tra
re
a
ar
y
nc
rin
/p
a
ru
r/b
ile
U
du
ct
pp
e
we
r
Lo
)
)
(2
5
in
f
(4
7
in
f
ct
tra
ar
y
Lo
ur
in
we
r
an
d
G
It
jo
i
nt
ra
c
(2
1
t(
94
2)
)
)
0%
Li
ve
Results: 54 hospitals participated in the study. 3,912 adult patients (4,117 recorded therapies) out of 12,623
admitted were treated with antimicrobial agents. 783 (19%) of the therapies were given as prophylaxis.
584 therapies (668 antibiotics) were given as peri-operative prophylaxis and 199 (212) as medical prophylaxis.
The distribution of diagnosis groups for peri-operative prophylaxis was; bone and joint 211 (36%),
cardiovascular system 65 (11%), lower gastrointestinal tract 57 (10%) and genital infections 55 (9%).
Antibiotics given, in percent DDD, were; beta-lactamase resistant penicillins 51%, cephalosporins 19%,
quinolones 6% and imidazole derivatives 5%. 90% of the peri-operative prophylaxis was given within the
surgical specialities (gynaecology, surgical speciality, orthopaedics, urology and ENT). In 44% an antibiotic
was prescribed for more than 24 hours.
The distribution of diagnosis groups for medical prophylaxis was; mouth and throat 31 (16%), pulmonary
infections 31 (16%), primary septicaemia 23 (12%), lower urinary tract 16 (8%) and lower gastrointestinal tract
15 (8%). Antibiotics given, in percent DDD, were; quinolones 22%, beta-lactamase resistant penicillins 15%,
triazole derivatives 15%, cephalosporins 12% and co-trimoxazole 12%.
Medical prophylaxis:
• 199 therapies (212 antibiotics)
• 62% of the therapies were related to
immunosuppression
Nitroimidazole (P01A)
Other antibacterials (J01X)
Fluoroquinolones (J01M)
Aminoglycosides (J01G)
Macrolides, lincosamides (J01F)
Sulfonamides and trimethoprim (J01E)
Other betalactams (J01D)
Penicillins (J01C)
Tetracyclines (J01A)
Intestinal antiinfectives (A07A)
80%
ne
Method: A nation wide PPS was performed within a two-week period in November 2003. A study physician
visited each participating hospital ward. 19 pre-defined diagnosis groups (reason for prophylaxis) were used.
The protocol was designed to present demographic data as well as the amounts and indications for
antimicrobial agents against bacteria and fungi. Prophylaxis was defined as peri-operative and medical
prophylaxis. Medical prophylaxis included therapy reasons like e.g. immunosuppression, HIV and recurrent
UTI.
90%
Duration of peri-operative prophylaxis
All peri-operative prophylaxis in surgical departments
90%
Peri-operative prophylaxis:
• 584 therapies (668 antibiotics)
• 44% were administred for >24 hours
80%
Proportion antibiotics
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 diagnosis. Using a web-based reporting system the STRAMAgroups have performed the first point prevalence study, PPS.
100%
Bo
POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN SWEDISH HOSPITALS – PROPHYLAXIS IN ADULTS
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 Stockholm, Sweden
54 hospitals participated in the study. 3 912 adult
patients (4 117 recorded therapies) out of 12 623
admitted patients were treated with antimicrobial
agents. 783 (19%) of the therapies were given as
prophylaxis.
Proportion antibiotics
Abstract
Prescribed antibiotics in peri-operative prophylaxis
Selected diagnosis groups
Prophylaxis per diagnosis group
70%
60%
50%
40%
30%
20%
10%
0%
ENT surgery (19)
30%
10%
>24 hours
Duration of peri-operative prophylaxis per diagnosis group
5%
250
Number of antibiotics
Bo
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Medical prophylaxis, distribution of antibiotics (tot 152 DDD)
It
jo
in
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ct
0
20%
Single dose
24 hours
>24 hours
15%
10%
Number of antimicobials used in general surgery
Single dose and long (>24 hours) prophylaxis
5%
40
Is
ox
az
ol
Tr
yl
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pc
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ox
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az
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ad
la
sp
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as
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it r
oi
m
id
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ar
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pe
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m
s
A
nt
im
yc
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Te
tra
cy
cl
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Tr
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et
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of
r im
ur
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uo
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qu
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s
35
Single dose
30
>24 hours
25
20
15
10
5
Peri-operative prophylaxis, distribution of antibiotics (tot 848 DDD)
en
Er
ta
p
ip
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em
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zo
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G
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ta
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C
ep
h
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in
s
60%
e
0
40%
30%
20%
10%
0%
Peri-operative prophylaxis in general surgery
Antibiotics related to diagnosis group
70
60
Upper urinary tract
Liver/bile duct/pancreas/spleen
50
40
Skin and soft tissue
Upper GI tract
Lower GI tract
30
Genital infections
Lower urinary tract
20
Cardiovascular system
10
C
ep
ha
lo
sp
Fl
or
uo
in
ro
s
qu
(J
01
i
Im
no
D
id
l
o
A)
az
ne
ol
s
e
(J
de
01
riv
M
C
A)
at
oes
tri
(J
m
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ox
XD
az
N
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oi
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m
01
id
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EE
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ol
)
e
Is
s
w
ith
ox
(P
01
az
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ol
AB
te
y
nd
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ed
c
(
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sp
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ec
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F)
m
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(J
tra
01
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kl
A)
in
Li
e
s
nc
(J
os
C
01
am
om
AA
i
de
bi
)
na
s
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(J
01
ns
FF
of
)
C
p
ar
c
ba
(J
01
pe
CR
ne
Am
m
)
in
s
og
(
J0
N
ly
itr
1D
c
o
of
si
H
ur
de
)
an
s
(J
de
01
riv
G
at
B)
iv
es
(J
01
XE
)
0
E-mail: [email protected]
[email protected]
24 hours
All surgical
departments (603)
Medical prophylaxis
Is
ox
az
ol
yl
pc
C
ep
ha
lo
sp
or
Fl
in
uo
s
ro
qu
in
ol
Im
on
id
es
a
zo
P
c
le
w
de
it h
riv
ex
at
te
es
nd
ed
sp
ec
tru
m
C
otri
m
ox
az
ol
e
Te
tra
cy
cl
in
es
N
it r
oi
m
id
az
ol
e
B
L
in
et
co
ala
sa
ct
m
am
id
es
as
e
se
ns
iti
ve
pc
Tr
im
et
op
r im
C
ar
ba
pe
C
ne
om
m
s
bi
na
t io
ns
of
A
pc
m
in
og
ly
co
si
de
s
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
Orthopaedics (216) Gynaecology (55)
15%
Number of antibiotics
A study physician visited each participating
hospital ward. Data were collected for all
hospitalized patients according to medical
records. Prophylaxis was defined as peri-operative
(single dose, 24 hours, >24 hours) and medical
prophylaxis. Medical
prophylaxis included
Diagnosis groups
therapy reasons like e.g.
immunosuppression,
HIV and recurrent UTI.
The indication for
prophylaxis was further
defined by 19 pre-defined
diagnosis groups.
Peri-operative prophylaxis
0%
Proportion DDD
Method
General surgery
(205)
Single dose
20%
Proportion DDD
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.
Data are presented on the prophylactic use of
antimicrobials from the first nation wide point
prevalence study, PPS, performed in Sweden.
Other surgery (68)
25%
Proportion of therapies
Introduction and purpose
Urology (40)
CNS
Conclusions
• Peri-operative prophylaxis was long, 44% was
>24 hours.
• 50% of all peri-operative prophylaxis (DDD)
was isoxazolyl pc.
• Cephalosporins, fluoroquinolones and
imidazoles were the most frequently used
antibiotics in peri-operative prophylaxis.
• The same antibiotics are used in both
prophylaxis and in therapy.