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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
POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN HOSPITALISED PEDIATRIC PATIENTS IN SWEDEN
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. We present data on pediatric patients from the first nation wide point prevalence study, PPS, performed in Sweden.
MethodsThe 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. 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.
Results28 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.
E-mail: [email protected] [email protected]
266 included children (141 girls, 125 boys) 279 different therapies were recorded;251 in departments of pediatrics (28%) 28 in wards for adults29% were related to immunosuppression and foreign material infections.
Cultures were taken before oral treatment in 68% and before parenteral treatment in 73%.
The distribution of diagnosis groups and therapy reasons in treated children:
The antimicrobials used in 258 treatments for CAI and HAI were:
Antimicrobials used for treatment of three community acquired infections (CAI):
Antimicrobials used in 47 septicaemia treatments:
The length of peri-operative prophylaxis was too long , >1 day, in 59% of all therapies.
86% of all treatments were assessed as adequate.
ConclusionsThe 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
AbstractObjectives: 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.
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 pre-defined diagnosis groups were used. Children were identified as patients 0-16 years old.
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.
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.
Diagnose 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
PPS 2003 47 septicaemia therapies with 65 different antimicrobials in children
0
2
4
6
8
10
12
Cla
fora
n
Fortu
m
Vancocin
inf
Am
inogly
co
Zin
acef
Bensylp
enic
illin
Dokta
cillin
Tie
nam
Mero
nem
Bactrim
mix
t
Ekvacillin
Hera
cillin
Imacillin
Rocephalin
Antifu
ngals
Nu
mb
er o
f thera
pie
s
PPS 2003 Children (0-16 y) - treatment for CAI and HAI (258 antimicrobials)
0
20
40
60
80
100
120
J01D
AC
epha
losp
orin
s
J01C
E Be
ta-
lact
amas
e se
nspc J01D
HC
arba
pene
ms
J01X
AG
lyco
pept
ids
J01G
BAm
inog
lyco
sids
J01E
E C
o-tri
mox
azol
es
J01C
F Is
oxaz
olyl
-pc
J01M
AFl
uoro
quin
olon
es
J01C
A Br
oad
spec
trum
Pc
J01X
D Im
idaz
oles
J02A
C T
riazo
les
J01F
FLi
nkos
amid
es
J01F
A M
akro
lides
J02A
AAn
tifun
gas
Oth
ers
Num
ber o
f the
rapi
es
PPS 2003 Children (0-16 y) - diagnose group and reason of therapy (279 therapies)
0
5
10
15
20
25
30
35
40
45
50
Septic
aem
ia
Pneum
onia
Upper
urinary
tra
ct
inf
Low
er
GI tr
act in
f
Skin
and s
oft
tissue in
f
Mouth
and thro
ut
Bone a
nd jo
int in
f
Upper
airw
ay in
f
CN
S
Bro
nchiti
s
Vascula
r in
f
Fever
Low
er
urinary
tract in
f
Liv
er
and b
ile in
f
Genita
l inf
Upper
GI tr
act in
f
Ente
ric in
f
Un-s
pecifi
ed in
f
Nu
mb
er
of
thera
pie
s
Medical prophylaxis
Perioperative prophylaxis
HAI
CAI
PPS 2003 Antimicrobials used in three community acquired infections in children
0
2
4
6
8
10
12
14
16
J01
CE
Be
ta-
lact
am
ase
se
ns
pc
J01
CF
Iso
xa-p
c
J01
DA
Ce
ph
alo
spo
rin
s
J01
DF
Mo
no
ba
cta
me
s
J01
DH
Ca
rba
pe
ne
me
s
J01
EE
Co
-tr
imo
xazo
les
J01
FA
Ma
cro
lide
s
J01
FF
Lin
cosa
mid
es
J01
MA
Flu
oro
qu
ino
lon
es
J01
GB
Am
ino
gly
cosi
de
s
P0
1A
BN
itro
imid
azo
les
Nu
mb
er
of
the
rap
ies
Pneumonia, 23 Skin and soft tissue inf, 17 Upper urinary tract inf, 22
Antimicrobials used in 82 therapies as prophylaxis (%):
peri-operative (49) medical (33)Cephalosporins 49 12Isoxa-pc 22 3Nitroimidazoles 12 3Beta-lact sens pc 4 12Co-trimoxazole 2 36Trimetoprim 2 12
The therapy reason for treatment was:CAI in 52%, 14% of all admittedHAI in 23%, 7% of all admittedProphylaxis in 25%, 7% of all admitted
