Changes in patterns of antimicrobial use in Swedish hospitals from 2003 to 2006 following the introduction of large-scale nationwide point prevalence studies

Abstract number: O404

Erntell M., Skoog G., Cars O., Elowson S., Hanberger H., Jorup C., Odenholt I., Prag M., Skärlund K., Struwe J., Torell E., Ulleryd P.

Objectives: The objective of the studies was to perform descriptive point prevalence studies (PPS) of antimicrobial use in relation to diagnoses in Swedish hospitals.

Method: The protocol was designed to present demographic data as well as the amounts and indications for antimicrobial agents. Treatments were recorded in relation to diagnoses, prophylactic use, community acquired (CAI) and hospital acquired infection (HAI). Three nation-wide PPS were performed in November 2003, 2004 and 2006. Three areas were identified for intervention before the last PPS; duration of peri-operative prophylaxis, treatment of community-acquired pneumonia, use of fluoroquinolones in community-acquired cystitis in women. Direct information to all hospital physicians and feed-back of earlier results was used as the intervention strategy.

Results: 13,420 patients treated with antimicrobial agents in 54, 49 and 64 hospitals were included in the three PPS. The number of admitted patients corresponds to 50–75% of all admitted patients in Sweden during one day. 32.5–34.9% of the admitted patients were treated with antimicrobials. The indication for treatment was CAI in 17.0–18.0%, HAI in 9.2–9.9% and prophylaxis in 6.3%. For adults cultures were taken before oral treatment in 60% and before parenteral treatment in 70%. Only minor changes in the patterns of the overall use of antimicrobials were observed. However, in lower urinary tract infections of women the relative use of mecillinam and trimethoprim increased from 36 to 44% and from 22 to 26%, respectively, while the use of fluoroquinolones decreased from 25 to 13%. For community acquired pneumonia no significant changes were observed. The 2006 PPS result shows a decrease of peri-operative treatments longer than one day from 47% in 2003 to 31% in 2006. The one-dose peri-operative prophylaxis in the lower gastrointestinal tract has increased from 62% to 77%. The total amount of antimicrobials used for adults was 40.3, 43.1 and 43.3 DDD/100 admitted patients, respectively.

Conclusions: The PPS method has become a valuable tool in Sweden to describe the patterns of antibiotic use. The 2006 PPS showed after the interventions during 2005 and 2006 changes of antimicrobial use in peri-operative prophylaxis with shorter therapies and less fluoroquinolones in treatment of community acquired cystitis in women. However, in treatment of community acquired pneumonia cephalosporins still dominates and are included in more than 35% of all therapies.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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