Repeated nationwide point-prevalence surveys of antimicrobial use in Swedish hospitals: data for actions 2003–2010

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.

Lessons learnt during 20 years of the Swedish strategic programme against antibiotic resistance

“…Point prevalence surveys of infections and antibiotic use in a large sample of Swedish acute care hospitals by local multiprofessional groups (years 2003, 2004, 2006, 2008 and 2010). 17 …”

“…Since 2007, the increasing global spread of extended-spectrum β-lactamase (ESBL-) producing Enterobacteriacae has motivated national and local interventions targeting hospital prescribers. 17 , 21 The result was a substantial reduction between 2007 and 2009 in the use of cephalosporins, and an increase in the use of narrow-spectrum penicillins, which continue to date ( Fig. 2 ).…”

“…Repeated studies between 2003 and 2010 showed that around one-third of all hospitalized patients received antibiotics during each year of the surveys. 17 …”

Fear and hierarchy: critical influences on antibiotic decision-making in the operating theatre

“…Successful interventions to improve SAP prescribing include studies in both resource limited and resource rich settings, and include the collaborative development of guidelines, data collection on compliance with guidelines and quality assurance cycles with audit and direct prescriber feedback [7,[9][10][11]. However, in both contexts suboptimal SAP prescribing persists, and barriers to implementation are evident, including the enduring belief within surgery regarding the benefit of post-operative SAP administration to prevent SSI [10,12,13]. This raises an important question: in contexts where there are One consistently under-emphasised aspect -with emerging evidence reinforcing its critical importance [14] -is the influence of social factors in antimicrobial decisionmaking.…”

Point Prevalence Surveys of Antimicrobial Use among Hospitalized Children in Six Hospitals in India in 2016

“…Surveillance of antimicrobial use in hospitals can provide an insight into patterns of antimicrobial use, help highlight differences in prescribing practices among hospitals, and identify opportunities for improvement. Information on antimicrobial use from point prevalence surveys (PPSs) could be used to design, implement, and assess the effects of antimicrobial policies [ 6 ]. To date, only one multicenter (>2 hospitals) study describing antimicrobial use among hospitalized children has been published in India [ 7 ].…”