663 ESAC Point Prevalence Survey of Antibiotic Use in 134 European Hospitals in 2009

Saturday, March 20, 2010: 2:15 PM
International North (Hyatt Regency Atlanta)
Peter Zarb, M.Phil , Mater Dei Hospital, Msida, Malta
Brice Amadeo, MSc , Inserm, Bordeaux, France
Arno Muller, PhD , University of Antwerp, Antwerp, Belgium
Vanessa Vankerckhoven, PhD , University of Antwerp, Antwerp, Belgium
Peter Davey, Professor , Division of Community and Population Sciences and Education, Dundee, United Kingdom
Herman Goossens, MD, PhD , University Hospital of Antwerp, Edegem, Belgium

Background: The European Surveillance of Antimicrobial Consumption (ESAC) collects data on antimicrobial use. Simultaneously, data on antimicrobial resistance is collected by the European Antimicrobial Resistance Surveillance System (EARSS). ESAC and EARSS provide Pan-European trends on antimicrobial use and resistance.

Objective: To perform a Point Prevalence Survey (PPS) on antimicrobial prescription in European hospitals.

Methods: Data were collected during a maximum of two calendar weeks from May to November 2009 in 134 hospitals in 21 European countries. The study protocol was based on the version of the PPS-2008. A web-based application was developed for online data entry. Antimicrobial prescriptions were recorded using the WHO ATC classification. Data on treated patients, indications, diagnoses, adherence to guidelines and ‘reasons for treatment recorded in notes' were collected.

Results: Among the 59,700 admitted patients, 17,632 (30%) received antimicrobials for a total of 25,066 therapies of which 16,887 (67%) were monotherapy. Antibacterials (J01) represented 90% of the prescriptions (range: 58-100). The most commonly prescribed antibiotics were penicillins with β-lactamase inhibitor (10%, range: 0-49), cephalosporins (6.6%, range: 0-31), and fluoroquinolones (4%, range: 0-40). In contrast, in intensive care, carbapenems were the second most used class (11%, range: 0-50), followed by glycopeptides (9%, range 0-50). The overall proportion of parenteral use was 61%. Infections represented 81% of all the indications. Among the treatments, 62% were for community-acquired-infections. Monotherapy accounted for 66% of all treatment, bi-therapy 27% and >2 drugs 7%. The most frequent combinations included a β-lactam antibiotic plus either metronidazole or clarithromycin. Respiratory and skin-soft-tissue-bone-joint infections were the predominant infection sites, accounting for 27% and 19%, respectively. Surgical prophylaxis represented 13% of all indications and 70% of all prophylaxis. The >1 day duration of surgical prophylaxis, even though still high (47%), was not as high as in 2006 (56%) or 2008 (65%). The use of single dose pre-operative prophylaxis was 29% (range: 0-92).

Conclusions: The PPS-2009 results, based on a larger sample, are in accordance with both the PPS-2006 and PPS-2008 data. The survey confirmed that excessively long duration of surgical prophylaxis remains an issue across European hospitals. The apparently unconventional combination of drugs (e.g., metronidazole and co-amoxiclav, both of which have sufficient anti-anaerobic cover) was another problem identified in this survey. This type of PPS enables the identification of inappropriate prescribing enabling the individual hospitals to intervene and improve their current practices.