Abstract
BackgroundPatient-level surveillance (indication, appropriate choice, dosing, route, duration) of antimicrobial use in Canadian hospitals is needed to reduce antimicrobial overuse and misuse. Patient-level surveillance has not been performed on a national level in Canada. The Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) is an international collaborative to monitor antimicrobial use and resistance in hospitals worldwide. Global-PPS locally documents on a single day patient-level antimicrobial prescribing practices. This article presents the results of the 2017 Global-PPS in Canadian hospitals with established antimicrobial stewardship programs.MethodsHospitals part of the Canadian Nosocomial Infection Surveillance Program were invited to participate. Surveys could be performed any time in the 2017 calendar year. All in-patient wards in each hospital were surveyed by a physician, pharmacist or nurse with infectious disease training.ResultsFourteen Canadian hospitals participated in the survey. Of 4118 patients, 1400 patients (34.0%) received a total of 2041 antimicrobials. Overall, 73.1% (n = 1493) of antimicrobials were for therapeutic use, 14.2% (n = 288) were for medical prophylaxis, 8.3% (n = 170) were for surgical prophylaxis, 1.8% (n = 37) were for other reasons, and 0.2% (n = 3) were used as prokinetic agents. Only 2.5% (n = 50) were for unknown reasons. For antimicrobials for therapeutic use, 29.9% of patients were treated for lower respiratory tract (343/1147), 10.5% for intra-abdominal (120/1147), 9.3% for skin and soft tissue (107/1147) and 7.5% for gastro-intestinal (86/1147) infections.ConclusionsStandardized methodology amongst Global-PPSs allows the comparison of our results to the 2015 Global-PPS. The prevalence of antimicrobial use on medical, surgical, and intensive care wards are similar to those previously observed in North America. Indication of antimicrobials has not been previously reported on such a large scale in Canadian hospitals. This report serves as a comparison for further point prevalence surveys that are currently underway. It will be used for identifying opportunities and benchmarking in antibiotic stewardship.
Highlights
Patient-level surveillance of antimicrobial use in Canadian hospitals is needed to reduce antimicrobial overuse and misuse
The prevalence of antimicrobial use on medical, surgical and intensive care wards are similar to those previously observed in North America in the 2015 Global-point prevalence surveys (PPS) [8]
surgical prophylaxis (SP) is routinely used for most surgeries, it accounted for only 17.5% of antimicrobial consumption on adult surgical wards with therapeutic use at 71.4%
Summary
Patient-level surveillance (indication, appropriate choice, dosing, route, duration) of antimicrobial use in Canadian hospitals is needed to reduce antimicrobial overuse and misuse. As part of the Framework, the Canadian Nosocomial Infection Surveillance Program (CNISP) monitors AMU in participating Canadian hospitals. Population-level AMU surveillance through DDDs lacks patient-level information, and qualitative surveillance (indication, appropriate choice, dosing, route, duration) is required to interpret quantitative aspects and to guide complete antimicrobial stewardship interventions [5]. Patient-level surveillance of AMU in Canadian hospitals is needed to reduce antimicrobial overuse and misuse. The CNISP performed patient-level AMU surveillance in the past through point prevalence surveys (PPS) of healthcareassociated infections (HAIs) [6]. Patient-level AMU surveillance has not been performed on a national level in Canada
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