Skoog G, Cars O, Skärlund K, Elowson S, Hanberger H, Odenholt I, Prag M, Struwe J, Torell E,...
1
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 POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN SWEDISH HOSPITALS - PROPHYLAXIS IN ADULTS Introduction and purpose 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. Method 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 therapy reasons like e.g. immunosuppression, HIV and recurrent UTI. The indication for prophylaxis was further defined by 19 pre-defined diagnosis groups. Results 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. Medical prophylaxis: • 199 therapies (212 antibiotics) • 62% of the therapies were related to immunosuppression Peri-operative prophylaxis: • 584 therapies (668 antibiotics) • 44% were administred for >24 hours Duration of peri-operative prophylaxis 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. Abstract 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 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 STRAMA-groups have performed the first point prevalence study, PPS. 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. 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%. 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. Diagnosis groups 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 P eri-operative prophylaxis,distribution ofantibiotics (tot848 D D D ) 0% 10% 20% 30% 40% 50% 60% P ro p o rtio n D D P rescribed antibiotics in peri-operative prophylaxis S elected diagnosis groups 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% B one and joint(212) Low erG It ract( 94) Low erurinary tracti nf(47) U pperur inary tractinf(25) Liv er/bile duct/pancreas/sple en (19) P roportion antibiotics Nitroim idazole (P01A) O therantibacterials (J01X) Fluoroquinolones (J01M) Am inoglycosides (J01G) Macrolides,lincosam ides (J01F) Sulfonam ides and trim ethoprim (J01E) O therbetalactam s (J01D ) Penicillins (J01C ) Tetracyclines (J01A) Intestinal antiinfectives (A07A) Peri-operative prophylaxis in generalsurgery A ntibiotics related to diagnosis group 0 10 20 30 40 50 60 70 N um berofantibiotics U pperurinary tract Liver/bile duct/pancreas/spleen S kin and softtissue UpperG Itract LowerG Itract Genitalinfections Low erurinary tract C ardiovascularsystem CNS M edicalprophylaxis,distribution ofantibiotics (tot152 D D D ) 0% 5% 10% 15% 20% 25% P ro p o rtio n D DD Prophylaxis perdiagnosis group 0% 5% 10% 15% 20% 25% 30% P roportion oftherapies P eri-operative prophylaxis M edical prophylaxis Num berofantim icobials used in generalsurgery Single dose and long (>24 hours)prophylaxis 0 5 10 15 20 25 30 35 40 S ingle dose >24 hours A llperi-operative prophylaxis in surgicaldepartm ents 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% E N T surgery (19) U rology (40) O thersurgery (68) Generalsurgery (205) O rthopaedics (216) G ynaecology (55) Allsurgical departm ents (603) Proportion antibiotics S ingle dose 24 hours >24 hours D uration ofperi-operative prophylaxis perdiagnosis group 0 50 100 150 200 250 Bo ne and j oin t Low erGItract Genitalinfec t ions Ca rd iovascul arsy s t e m Skin and softtissue Low erurinary tract U pperGItract U pperurinary tr act Liver/bile du ct/pancre as/spl e en CNS M outh and t hroat Pul m onary i n fections U pper resp i rato r y tract Sept i caem i a ,pr im ary Inf ectious G Idiseas e s Num ber ofantibiotics S ingle dose 24 hours >24 hours
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Transcript of Skoog G, Cars O, Skärlund K, Elowson S, Hanberger H, Odenholt I, Prag M, Struwe J, Torell E,...
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
POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN SWEDISH HOSPITALS - PROPHYLAXIS IN ADULTS
Introduction and purposeData 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.
MethodA 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 therapy reasons like e.g. immunosuppression, HIV and recurrent UTI. The indication for prophylaxis was furtherdefined by 19 pre-defined diagnosis groups.
E-mail: [email protected] [email protected]
Results54 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.
Medical prophylaxis: • 199 therapies (212 antibiotics) • 62% of the therapies were related to immunosuppression
Peri-operative prophylaxis: • 584 therapies (668 antibiotics)• 44% were administred for >24 hours
Duration of peri-operative prophylaxis
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.
AbstractPOINT PREVALENCE STUDY OF ANTIBIOTIC USE IN SWEDISH HOSPITALS – PROPHYLAXIS IN ADULTSSkoog 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 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 STRAMA-groups have performed the first point prevalence study, PPS.
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.
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%.
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.
Diagnosis groups Central nervous systemOphthalmic infectionsMouth and throatUpper respiratory tractBronchitisPulmonary infectionsCardiovascular systemUpper gastrointestinal tractLower gastrointestinal tractInfectious gastrointestinal diseasesLiver/bile duct/pancreas/spleenSkin and soft tissueBone and jointLower urinary tract infectionUpper urinary tract infectionGenital infectionsSepticaemia, primaryUn-specified indication, fever Indication unclear
Peri-operative prophylaxis, distribution of antibiotics (tot 848 DDD)
0%
10%
20%
30%
40%
50%
60%
Pro
po
rtio
n D
DD
Prescribed antibiotics in peri-operative prophylaxis Selected diagnosis groups
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Bone
and
joint
(212
)
Lower
GI t
ract
(94)
Lower
urin
ary t
ract
inf (4
7)
Upper
urin
ary t
ract
inf (2
5)
Liver
/bile
duc
t/pan
crea
s/spl
een
(19)
Pro
po
rtio
n a
nti
bio
tic
s 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)
Peri-operative prophylaxis in general surgeryAntibiotics related to diagnosis group
0
10
20
30
40
50
60
70
Nu
mb
er o
f an
tibio
tics
Upper urinary tract
Liver/bile duct/pancreas/spleen
Skin and soft tissue
Upper GI tract
Lower GI tract
Genital infections
Lower urinary tract
Cardiovascular system
CNS
Medical prophylaxis, distribution of antibiotics (tot 152 DDD)
0%
5%
10%
15%
20%
25%
Pro
po
rtio
n D
DD
Prophylaxis per diagnosis group
0%
5%
10%
15%
20%
25%
30%
Pro
po
rtio
n o
f th
era
pie
s
Peri-operative prophylaxis Medical prophylaxis
Number of antimicobials used in general surgery Single dose and long (>24 hours) prophylaxis
0
5
10
15
20
25
30
35
40
Single dose
>24 hours
All peri-operative prophylaxis in surgical departments
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
ENT surgery (19) Urology (40) Other surgery (68) General surgery(205)
Orthopaedics (216) Gynaecology (55) All surgicaldepartments (603)
Pro
po
rtio
n a
ntib
iotic
s
Single dose 24 hours >24 hours
Duration of peri-operative prophylaxis per diagnosis group
0
50
100
150
200
250
Bone
and
joint
Lower
GI t
ract
Genita
l infe
ction
s
Cardio
vasc
ular s
ystem
Skin a
nd so
ft tis
sue
Lower
urin
ary t
ract
Upper
GI t
ract
Upper
urin
ary t
ract
Liver
/bile
duc
t/pan
crea
s/sple
en CNS
Mou
th a
nd th
roat
Pulmon
ary i
nfec
tions
Upper
resp
irato
ry tra
ct
Septic
aemia,
prim
ary
Infec
tious
GI d
iseas
es
Nu
mb
er o
f an
tib
ioti
cs
Single dose 24 hours >24 hours
