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.
Highlights
The Swedish Strategic Programme Against Antibiotic Resistance (Strama) was established during the 1990s to promote rational use of antibiotics [1]
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
This paper presents an analysis of antimicrobial use related to diagnosis in Swedish hospitals and experiences from interventions based on findings in five point-prevalence survey (PPS) from 2003 to 2010
Summary
The Swedish Strategic Programme Against Antibiotic Resistance (Strama) was established during the 1990s to promote rational use of antibiotics [1]. At that time in Sweden, data on antimicrobial use in hospitals was limited to statistics on the total amount of deliveries from hospital pharmacies [2]. While such data allow analysis over time and comparison of patterns of antimicrobial use among hospitals and regions, they do not include the indication for therapy and do not permit assessment of compliance with recommendations. Knowledge of antimicrobial use in Swedish hospitals was largely restricted to local projects [3] when the national Strama board [1] initiated the nationwide point-prevalence survey (PPS) in 2003. Numbers are small when looking only at one hospital but if data are collected for several hospitals, and surveys are repeated, data becomes more reliable
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