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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 - PowerPoint PPT Presentation
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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 StudiesPPS 2003, 2004 and 2006
(For method, Skoog, ECCMID 2004)
2003 2004 2006• No of hospitals 54 49 64• No of admitted pat 13,536 11,348 17,113• No of therapies 4,396 3,841 6,012• Therapies, total no 14,249
PPS 2003 / 2004 / 2006Therapyreasons
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• Total32,5 33,9 34,9
Antibiotic ”pressure” PPS 2003 - 2006 DDD/100 admitted patients
• PPS 2003 40.3• PPS 2004 43.1• PPS 2006 43.3
• ESAC PPS 2006 47.6(ECCMID 2007)
Relative distribution of antibiotics in treatment of community acquired infections, PPS 2003 and 2006
0,0
5,0
10,0
15,0
20,0
25,0
30,0
Per c
ent o
f tot
al D
DD
2003
2006
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 Längd av peroperativ profylax vid colo-rectal kirurgi, riket, procentuell fördelning
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
2003, N 69 2004, N 43 2006, N 47
Per c
ent
Prophylaxis one dose Prophylaxis one day Prophylaxis >1 day
PPS 2003 – 2006 Length of perioperative prophylaxis in colo-rectal
surgery
Patterns of treatment of community acquired pneumonia at Dept of Internal medicin PPS 2003-2004 compared to PPS 2006
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
Per c
ent o
f tot
al D
DDs
2003+2004, 854 DDD 2006, 667 DDD
Treatment for community acquired pneumonia at Depts. of Internal medicine, PPS 2003+2004 compared to PPS 2006
PPS 2003 - 2006 Treatment of community acquired cystitis in women
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
45,0
50,0
J01CA Broadspectrum Pc
J01DB First gencephalosporines
J01DC Secondgen
cephalosporines
J01EATrimethoprim
J01EE Co-trimoxazole
J01MAFluoroquinolones
J01XE Nitrofuranderivatives
Others
Per c
ent o
f the
rapi
es
2003, No 151 2004, No 163 2006, No 215
Treatment of community acquired cystitis in womenPPS 2003 - 2006
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
45,0
Postoperative infections Other device relatedinfections
C. difficile enterocolitis Other HAI HAI from other hospitals
Per c
ent o
f all
HA
I
PPS 2003 1 239 PPS 2006 1 813
Hospital acquired infections (HAI), comparison between the PPS 2003 and 2006 of the different types
ConclusionsThe 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 programmeagainst antibiotic resistance