The ESAC PPS provided useful information on the quality of prescribing, which identified a number of targets for quality improvement. These could apply to specific departments or whole hospitals. Intensive care, which has different characteristics, should not be compared with general wards with respect to combination therapy, hospital-acquired infections or parenteral proportion. The study confirmed that the ESAC PPS methodology can be used on a large number of hospitals at regional, national, continental or global level.

OBJECTIVES:To evaluate a multi-method approach to postdischarge sur veillance of surgical-site infections (SSIs) and to identify infection rates and risk factors associated with SSI following cesarean section.DESIGN: Cross-sectional sur vey. SETTING: Academic tertiar y-care obstetric and gynecology center with 54 beds.PATIENTS: All women who delivered by cesarean section in Tartu University Women's Clinic during 2002.METHODS: Infections were identified during hospital stay or by postdischarge sur vey using a combination of telephone calls, healthcare worker questionnaire, and outpatient medical records review. SSI was diagnosed according to the criteria of the Centers for Disease Control and Prevention National Nosocomial Infections Sur veillance System. RESULTS:The multi-method approach gave a follow-up rate of 94.8%. Of 305 patients, 19 (6.2%; 95% confidence inter val [CI 95 ], 3.8-9.6) had SSIs. Forty-two percent of these SSIs were detected during postdischarge sur veillance. We found three variables associated with increased risk for developing SSI: internal fetal monitoring (odds ratio [OR], 16.6; CI 95 , 2.2-125.8; P = .007), chorioamnionitis (OR, 8.8; CI 95 , 1.1-69.6; P = .04), and surgical wound classes III and IV (OR, 3.8; CI 95 , 1.2-11.8; P = .02). CONCLUSIONS:The high response rate validated the effectiveness of this kind of sur veillance method and was most suitable in current circumstances. A challenge exists to decrease the frequency of internal fetal monitoring and to treat chorioamnionitis as soon as possible (Infect Control Hosp Epidemiol 2005;26:449-454). ABSTRACTThe single most important risk factor for postpartum maternal infection is delivery by cesarean section.1 Maternal morbidity related to infections has been shown to be eightfold higher after cesarean section than after vaginal delivery.2 Reducing the number of deliveries by cesarean section and identifying risk factors for post-cesarean surgical-site infections (SSIs) could contribute to a decrease in maternal morbidity.

A point-prevalence survey of five European university hospitals was performed to benchmark antimicrobial drug use in order to identify potential problem areas in prescribing practice and to aid in establishing appropriate and attainable goals. All inpatients at the university hospitals of Rijeka (Croatia), Tartu (Estonia), Riga (Latvia), Vilnius (Lithuania) and Karolinska-Huddinge (Sweden) were surveyed for antimicrobial drug use during a single day. The frequency of antimicrobial drug use was 24% in Rijeka, 30% in Tartu, 26% in Riga, 14% in Vilnius and 32% in Huddinge. Surgical patients were treated with antimicrobial agents more often than medical patients in Riga (53% vs. 31%), Tartu (39% vs. 26%) and Vilnius (54% vs. 25%). Two-thirds of patients in Rijeka, Tartu, Riga and Vilnius, and fewer than half of the patients in Huddinge, received antimicrobial agents intravenously. Broad-spectrum antimicrobial agents were used most commonly in Rijeka. The prevalence of nosocomial infections treated with antibiotics was 9% at Huddinge, and 3-5% at the other centres. Benchmarking antimicrobial drug use at five university hospitals identified differences and problem areas. The high rates of intravenous administration, poor compliance with guidelines, and prolonged surgical prophylaxis were general problems that deserved specific attention at all centres. A change in prescription practices may reduce unnecessary drug use and decrease antimicrobial resistance.

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This is the first study to use a standardized method for data collection and longitudinal analysis of antibiotic use in different hospitals. These data suggest that determination of changes in antibiotic exposure of hospital patients over a period of time is unreliable if only one clinical activity variable (such as OBDs) is used as the denominator. We recommend inclusion of admissions, OBDs and length of stay in statistical, time series analysis of antibiotic use. This model is also relevant to longitudinal analysis of infections in hospitals.