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Prescription of antibiotic agents in Swedish intensive care units is empiric and adequate
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
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2007 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 39, no 1, 63-69 p.Article in journal (Refereed) Published
Abstract [en]

Since the prescription of antibiotics in the hospital setting is often empiric, particularly in the critically ill, and therefore fraught with potential error, we analysed the use of antibiotic agents in Swedish intensive care units (ICUs). We examined indications for antibiotic treatment, agents and dosage prescribed among 393 patients admitted to 23 ICUs at 7 tertiary care centres, 11 secondary hospitals and 5 primary hospitals over a 2-week period in November 2000. Antibiotic consumption was higher among ICU patients in tertiary care centres with a median of 84% (range 58-87%) of patients on antibiotics compared to patients in secondary hospitals (67%, range 35-93%) and in primary hospitals (38%, range 24-80%). Altogether 68% of the patients received antibiotics during the ICU stay compared to 65% on admission. Cefuroxime was the most commonly prescribed antibiotic before and during admission (28% and 24% of prescriptions, respectively). A date for decision to continue or discontinue antibiotic therapy was set in 21% (6/29) of patients receiving prophylaxis, in 8% (16/205) receiving empirical treatment and in 3% (3/88) when culture-based therapy was given. No correlation between antibiotic prescription and laboratory parameters such as CRP levels, leukocyte and thrombocyte counts, was found. The treatment was empirical in 64% and prophylactic in 9% of cases. Microbiological data guided prescription more often in severe sepsis (median 50%, range 40-60% of prescriptions) than in other specified forms of infection (median 32%, range 21-50%). The empirically chosen antibiotic was found to be active in vitro against the pathogens found in 55 of 58 patients (95%) with a positive blood culture. This study showed that a high proportion of ICU patients receive antimicrobial agents and, as expected, empirical-based therapy is more common than culture-based therapy. Antibiotics given were usually active in vitro against the pathogen found in blood cultures. We ascribe this to a relatively modest antibiotic resistance problem in Swedish hospitals.

Place, publisher, year, edition, pages
2007. Vol. 39, no 1, 63-69 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-12665DOI: 10.1080/00365540600740504OAI: diva2:16800
Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2009-08-18
In thesis
1. Surveillance of Antibiotic Consumption and Antibiotic Resistance in Swedish Intensive Care Units
Open this publication in new window or tab >>Surveillance of Antibiotic Consumption and Antibiotic Resistance in Swedish Intensive Care Units
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Nosocomial infections remain a major cause of mortality and morbidity. The problem is most apparent in intensive care units (ICUs). Most ICU patients are compromised and vulnerable as a result of disease or severe trauma. One in ten people admitted to hospital is given an antibiotic for infection. The risk of acquiring a nosocomial infection in a European ICU is approximately 20%. It is vitally important that ways are found to prevent transmission between patients and personnel, and that local hygiene routines and antibiotic policies are developed. This thesis is a holistic work focused particularly on antimicrobial antibiotic resistance, antibiotic consumption and to some extent on hygiene in Swedish ICUs.

Aims: The general aim of this thesis was to investigate bacterial resistance and antibiotic consumption in Swedish ICUs and to try to correlate ICU demographic data with antibiotic consumption and antibiotic resistance. Additional aims were to investigate on which clinical indications antibacterial drugs are prescribed in the ICU, and to investigate the emergence of resistance and transmission of Pseudomonas aeruginosa in the ICU using cluster analysis based on antibiograms and genotype data obtained by AFLP.

Material and methods: In paper 1-3, antibiotic consumption data together with bacterial antibiotic resistance data and specific ICU-demographic data were collected from an increasing number of ICUs over the years 1997-2001. Data from ICUs covering up to six million out of Sweden’s nine million inhabitants were included. In paper 4, the indications for antibiotic prescribing were studied during two weeks in 2000. Paper 5 investigated Pseudomonas aeruginosa isolates in order to detect cross-transmission with genotype obtained by AFLP, and antibiogram-based cluster analysis was also performed in order to see if this could be a quicker and easier substitute for AFLP.

Results: This thesis has produced three important findings. Firstly, antibiotic consumption in participating ICUs was relatively high during the study period, and every patient received on average more than one antimicrobial drug per day (I-IV). Secondly, levels of antimicrobial drug resistance seen in S. aureus, E. coli and Klebsiella spp remained low when data were pooled from all ICUs throughout the study period, despite relatively high antibiotic consumption (I-V). Thirdly, the prevalence of antibiotic resistance in CoNS and E. faecium, cefotaxime resistance in Enterobacter, and ciprofloxacin and imipenem resistance in P. aeruginosa was high enough to cause concern.

Conclusion: For the period studied, multidrug resistance in Swedish ICUs was not a major problem. Signs of cross-transmission with non-multiresistant bacteria were observed, indicating a hygiene problem and identifying simple improvements that could be made in patient care guidelines and barrier precautions. A need for better follow up of prescribed antibiotics was evident. With further surveillance studies and monitoring of antibiotics and bacterial resistance patterns in the local setting as well as on a national and international level, some of the strategic goals in the prevention and control of the emergence of antimicrobial-resistant microbes may be achievable.

Place, publisher, year, edition, pages
Institutionen för molekylär och klinisk medicin, 2007
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1019
Bacterial Antibiotic resistance, Antibiotic Consumption, ICU, Surveillance programme, Multi drug resistance, Pseudomonas aeruginosa, ICU demography
National Category
Infectious Medicine
urn:nbn:se:liu:diva-10049 (URN)978-91-85895-77-9 (ISBN)
Public defence
2007-10-26, Elsa Brändströmsalen, University Hospital, Linköping University, 581 85 Linköping, 09:00 (English)
Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2009-08-22

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Gill, HansWalther, StenHanberger, Håkan
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Department of Clinical and Experimental MedicineFaculty of Health SciencesMedical InformaticsThe Institute of TechnologyPhysiology Department of Thoracic and Vascular SurgeryInfectious Diseases Department of Infectious Diseases in Östergötland
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