1887
Research article Open Access
Like 0

Abstract

This study sought to analyse antimicrobial pressure, indications for treatment, and compliance with treatment recommendations and to identify possible problem areas where inappropriate use could be improved through interventions by the network of the local Swedish Strategic Programme Against Antibiotic Resistance (Strama) groups. Five point-prevalence surveys were performed in between 49 and 72 participating hospitals from 2003 to 2010. Treatments were recorded for 19 predefined diagnosis groups and whether they were for community-acquired infection, hospital-acquired infection, or prophylaxis. Approximately one-third of inpatients were treated with antimicrobials. Compliance with guidelines for treatment of community-acquired pneumonia with narrow-spectrum penicillin was 17.0% during baseline 2003–2004, and significantly improved to 24.2% in 2010. Corresponding figures for quinolone use in uncomplicated cystitis in women were 28.5% in 2003–2004, and significantly improved, decreasing to 15.3% in 2010. The length of surgical prophylaxis improved significantly when data for a single dose and 1 day were combined, from 56.3% in 2003–2004 to 66.6% in 2010. Improved compliance was possibly the effect of active local feedback, repeated surveys, and increasing awareness of antimicrobial resistance. Strama groups are important for successful local implementation of antimicrobial stewardship programs in Sweden.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2016.21.25.30264
2016-06-23
2017-11-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.25.30264
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/21/25/eurosurv-21-30264-3.html?itemId=/content/10.2807/1560-7917.ES.2016.21.25.30264&mimeType=html&fmt=ahah

References

  1. Mölstad S, Erntell M, Hanberger H, Melander E, Norman C, Skoog G, et al. Sustained reduction of antibiotic use and low bacterial resistance: 10-year follow-up of the Swedish Strama programme. Lancet Infect Dis. 2008;8(2):125-32. https://doi.org/10.1016/S1473-3099(08)70017-3  PMID: 18222163 
  2. Public Health Agency of Sweden and National Veterinary Institute. Swedres-Svarm 2014. [Consumption of antibiotics and occurrence of antibiotic resistance in Sweden.] Solna/Uppsala: 2015. Available from: http://www.folkhalsomyndigheten.se/publicerat-material/publikationer/Swedres-Svarm-2014/
  3. Struwe J, Sjögren A. [Every tenth hospitalized patient is given antibiotics for a nosocomial infection]. Lakartidningen. 2002;99(32-33):3211-3. PMID: 12219475 
  4. The National Board of Health and Welfare. Statistical Database, In-patient Care Diagnoses. Stockholm: Socialstyrelsen. [Accessed 25 June 2014]. Available from: http://www.socialstyrelsen.se/statistics/statisticaldatabase/inpatientcarediagnoses
  5. Swedish Strategic Programme Against Antibiotic Resistance (Strama). Survey protocol in nationwide hospital point-prevalence surveys in Sweden, 2003–2010. [Accessed 22 June 2016]. Available from: http://strama.se/examples-of-projects/?lang=en
  6. World Health Organization Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index. Oslo: Norwegian Institute of Public Health. Updated 19 Dec 2013. Available from: http://www.whocc.no/atc_ddd_index/
  7. Ansari F, Erntell M, Goossens H, Davey P. The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis. 2009;49(10):1496-504. https://doi.org/10.1086/644617  PMID: 19842976 
  8. Zarb P, Amadeo B, Muller A, Drapier N, Vankerckhoven V, Davey P, et al. ESAC-3 Hospital Care Subproject Group. Identification of targets for quality improvement in antimicrobial prescribing: the web-based ESAC Point Prevalence Survey 2009. J Antimicrob Chemother. 2011;66(2):443-9. https://doi.org/10.1093/jac/dkq430  PMID: 21084362 
  9. Vlahović-Palcevski V, Dumpis U, Mitt P, Gulbinovic J, Struwe J, Palcevski G, et al. Benchmarking antimicrobial drug use at university hospitals in five European countries. Clin Microbiol Infect. 2007;13(3):277-83. https://doi.org/10.1111/j.1469-0691.2006.01613.x  PMID: 17391382 
  10. Berild D, Ringertz SH, Lelek M. Appropriate antibiotic use according to diagnoses and bacteriological findings: report of 12 point-prevalence studies on antibiotic use in a university hospital. Scand J Infect Dis. 2002;34(1):56-60. https://doi.org/10.1080/00365540110076912  PMID: 11874166 
  11. Andersen BM, Ringertz SH, Gullord TP, Hermansen W, Lelek M, Norman BI, et al. A three-year survey of nosocomial and community-acquired infections, antibiotic treatment and re-hospitalization in a Norwegian health region. J Hosp Infect. 2000;44(3):214-23. https://doi.org/10.1053/jhin.1999.0677  PMID: 10706805 
  12. Dumpis U, Gulbinovic J, Struwe J, Lagergren A, Griskevicius L, Bergman U. Differences in antibiotic prescribing in three university hospitals in the Baltic region revealed by a simple protocol for quality assessment of therapeutic indications. Int J Clin Pharmacol Ther. 2007;45(10):568-76. https://doi.org/10.5414/CPP45568  PMID: 17966843 
  13. Struwe J, Dumpis U, Gulbinovic J, Lagergren A, Bergman U. Healthcare associated infections in university hospitals in Latvia, Lithuania and Sweden: a simple protocol for quality assessment. Euro Surveill. 2006;11(7):167-71. PMID: 16966795 
  14. Gastmeier P, Sohr D, Forster D, Schulgen G, Schumacher M, Daschner F, et al. Identifying outliers of antibiotic usage in prevalence studies on nosocomial infections. Infect Control Hosp Epidemiol. 2000;21(5):324-8. https://doi.org/10.1086/501764  PMID: 10823565 
  15. European Centre for Disease Prevention and Control (ECDC). Annual Epidemiological Report on Communicable Diseases in Europe 2008. Stockholm: ECDC; 2008. Available from: http://ecdc.europa.eu/en/publications/Publications/0812_SUR_Annual_Epidemiological_Report_2008.pdf
  16. Medical Products Agency. Antibiotikaprofylax vid kirurgi - Behandlingsrekommendation [Antibiotic surgical prophylaxis - Treatment recommendations]. Information från Läkemedelsverket. 1998;9(7). Swedish. Available from: http://www.lakemedelsverket.se/malgrupp/Halso---sjukvard/Behandlingsrekommendationer-arkiv/Behandlingsrekommendation---arkivlista/Antibiotikaprofylax-vid-kirurgi/
  17. SBU - Swedish Council on Health Technology Assessment. Antibiotikaprofylax vid kirurgiska ingrepp, en systematisk litteraturöversikt - [Antibiotic prophylaxis during surgical procedures, a systematic literature review]. Stockholm: 2010 Report Number 200. Swedish. Available from: http://www.sbu.se/upload/Publikationer/Content0/1/Antibiotikaprofylax_fulltext.pdf
  18. Strålin KGG, Hedlund J, Lidman C, Spindler C, Örtqvist Å, Holmberg H. Handläggning av samhällsförvärvad pneumoni hos vuxna. Evidensbaserade riktlinjer från Svenska infektionsläkarföreningen. [Swedish guidelines for the management of adult patients with community-acquired pneumonia (CAP)]. Läkartidningen. 2008;105(38):2582-7. Swedish. Available from: http://www.lakartidningen.se/OldWebArticlePdf/1/10284/LKT0838s2582_2587.pdf
  19. Medical Products Agency. Nedre urinvägsinfektion (UVI) hos kvinnor - Behandlingsrekommendation [Lower Urinary Tract Infection (UTI) in women - Treatment recommendations]. Information från Läkemedelsverket.2007;18(2):8-45. Swedish. Available from: http://www.lakemedelsverket.se/malgrupp/Halso---sjukvard/Behandlings--rekommendationer/Behandlingsrekommendation---listan/UVI---Nedre-urinvagsinfektion-hos-kvinnor/
  20. Public Health Agency of Sweden. ESBL-producerande tarmbakterier [Extended-spectrum beta-lactamase-producing Enterobacteriaceae]. Stockholm: 2014. Swedish. Available from: http://www.folkhalsomyndigheten.se/publicerat-material/publikationer/ESBL-producerande-tarmbakterier/
  21. Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2013;4(4):CD003543. PMID: 23633313 
  22. Palmcrantz S, Tistad M, Eldh AC, Holmqvist LW, Ehrenberg A, Tomson G, et al. Assessing feasibility and acceptability of study procedures: getting ready for implementation of national stroke guidelines in out-patient health care. BMC Health Serv Res. 2015;15(1):517. https://doi.org/10.1186/s12913-015-1177-5  PMID: 26596624 
  23. Rycroft-Malone J, Seers K, Chandler J, Hawkes CA, Crichton N, Allen C, et al. The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework. Implement Sci. 2013;8(1):28. https://doi.org/10.1186/1748-5908-8-28  PMID: 23497438 
  24. Willemsen I, Groenhuijzen A, Bogaers D, Stuurman A, van Keulen P, Kluytmans J. Appropriateness of antimicrobial therapy measured by repeated prevalence surveys. Antimicrob Agents Chemother. 2007;51(3):864-7. https://doi.org/10.1128/AAC.00994-06  PMID: 17210766 
  25. Dimiņa E, Kūla M, Caune U, Vīgante D, Liepiņs M, Zeidaka L, et al. Repeated prevalence studies on antibiotic use in Latvia, 2003-2007. Euro Surveill. 2009;14(33):19307. PMID: 19712639 
  26. Amadeo B, Zarb P, Muller A, Drapier N, Vankerckhoven V, Rogues AM, et al. ESAC III Hospital Care Subproject Group. European Surveillance of Antibiotic Consumption (ESAC) point prevalence survey 2008: paediatric antimicrobial prescribing in 32 hospitals of 21 European countries. J Antimicrob Chemother. 2010;65(10):2247-52. https://doi.org/10.1093/jac/dkq309  PMID: 20713405 
  27. Laing RB, Mackenzie AR, Shaw H, Gould IM, Douglas JG. The effect of intravenous-to-oral switch guidelines on the use of parenteral antimicrobials in medical wards. J Antimicrob Chemother. 1998;42(1):107-11. https://doi.org/10.1093/jac/42.1.107  PMID: 9700538 
  28. Mertz D, Koller M, Haller P, Lampert ML, Plagge H, Hug B, et al. Outcomes of early switching from intravenous to oral antibiotics on medical wards. J Antimicrob Chemother. 2009;64(1):188-99. https://doi.org/10.1093/jac/dkp131  PMID: 19401304 
  29. Sevinç F, Prins JM, Koopmans RP, Langendijk PN, Bossuyt PM, Dankert J, et al. Early switch from intravenous to oral antibiotics: guidelines and implementation in a large teaching hospital. J Antimicrob Chemother. 1999;43(4):601-6. https://doi.org/10.1093/jac/43.4.601  PMID: 10350396 
  30. Kollef MH. Broad-spectrum antimicrobials and the treatment of serious bacterial infections: getting it right up front. Clin Infect Dis. 2008;47(S1) Suppl 1;S3-13. https://doi.org/10.1086/590061  PMID: 18713047 
  31. Andersen BM, Rasch M. Hospital-acquired infections in Norwegian long-term-care institutions. A three-year survey of hospital-acquired infections and antibiotic treatment in nursing/residential homes, including 4500 residents in Oslo. J Hosp Infect. 2000;46(4):288-96. https://doi.org/10.1053/jhin.2000.0840  PMID: 11170760 
/content/10.2807/1560-7917.ES.2016.21.25.30264
Loading

Data & Media loading...

Comment has been disabled for this content
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error