1. Skoog G, Cars O, Skärlund K, Elowson S, Hanberger H, Odenholt I, Prag M, Struwe J, Torell E, Ulleryd P, Erntell M. STRAMA, Swedish Institute for Infectious Disease Control, S-171 82 Solna, Sweden POINT PREVALENCE STUDIES (PPS) OF ANTIMICROBIAL USE IN SWEDISH HOSPITALS, 2003 AND 2004 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 from the first nation wide point prevalence studies, PPS, performed in Sweden. Methods The studies were performed within a two-week period in November 2003 and 2004 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 and hospital acquired infection. 19 pre-defined diagnosis groups were used. Results Results from the 333 hospital departments participating in both PPS 2003 and 2004 are presented below. Distribution of therapy reasons in treated patients Antimicrobials in DDD/100 admitted adult patients in different specialities Number of admitted patients, 2003/2004, in brackets Distribution of antimicrobials for treatment and prophylaxis. Pooled data from both studies. Distribution of antimicrobials in treatment of community acquired pneumonia Distribution of antimicrobials in treatment of lower urinary tract infection in women Proportion of peri-operative prophylaxis prescribed for >24 hours in some surgical specialities Total number of therapies, 2003/2004, in brackets Conclusions The PPS method was successfully introduced and has been an important tool to identify problem areas of antimicrobial hospital treatments. Cephalosporins were over-used in community acquired infections as pneumonia and skin and soft tissue infections A large fraction of women with cystitis were treated with fluoroquinolones Peri-operative prophylaxis was too long, >24 hours in over 40% of therapies www.strama.se E-mail: gunilla.skoog@smi.ki.segunilla.skoog@smi.ki.se mats.erntell@lthalland.se Abstract Background and Objective: 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. Design: Two PPS with one personal visit to each department were performed within a two- week period in November 2003 and 2004. 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 therapy reason (community acquired (CAI) or hospital acquired infection (HAI)). 19 pre-defined diagnosis groups were used. Prophylactic use was recorded in relation to prescribed doses. DDDs were calculated according to the WHO standard. A web-based reporting system was used to collect the data. Setting: Swedish hospitals, 31 different specialities. Main outcome measures: Antimicrobial use, in DDDs, in relation to diagnose and therapy reason. Results: The departments participating in both studies included 10 255 and 10 305 admitted patients respectively. Correspondingly 31% and 32% of the admitted patients were treated with antimicrobials. Distribution of women/men and adults/children were similar both years. The numbers of therapies were 3377 (54% CAI, 27% HAI, 19% prophylaxis) and 3523 (52% CAI, 28% HAI, 20% prophylaxis) respectively. A large fraction of women with cystitis were treated with fluoroquinolones (20% resp. 24%). The most common indication for cephalosporins (DDD) was community acquired pulmonary infections. Duration of peri-operative prophylaxis was more than 24 hours in about 40% of the cases. Conclusions: Demographic data from the two study periods were congruent. Analysis of antimicrobial use in relation to diagnose and therapy reason is an important tool to identify problem areas. Although the PPS method is time consuming, it was successfully introduced resulting in one of the largest surveys in Europe of antimicrobial hospital treatment. Diagnose groups Central nervous system Ophthalmic infections Mouth and throat Upper respiratory tract Bronchitis Pulmonary infections Cardiovascular system Upper gastrointestinal tract Lower gastrointestinal tract Infectious gastrointestinal diseases Liver/bile duct/pancreas/spleen Skin and soft tissue Bone and joint Lower urinary tract infection Upper urinary tract infection Genital infections Septicaemia, primary Un-specified indication, fever Indication unclear PPS20032004 No. of admitted patients 10 25510 305 No. of treated patients Distribution women / men Proportion children 3 212 (31%) 49.5 / 50.5% 5.6% 3 314 (32%) 49.8 / 50.2% 5.2% No. of therapies3 3773 523 No of antibiotics3 9474 068 No. of DDD´s4 0404 189 DDD/100 admitted39.440.6 PPS20032004 Community acquired54%52% Hospital acquired27%28% Prophylaxis19%20%