Use of antibiotics in nursing homes--surveillance with different methods.

BACKGROUND: Residents in nursing homes have a heightened risk of developing infections that should be treated with antibiotics. Inappropriate use of antibiotics may generate drug-related problems and increase resistance. In this study, we describe the use of antibiotics in nursing homes on the basis of prevalence surveys and drug sales statistics. MATERIAL AND METHODS: Five nursing homes in Oslo participated in two one-day surveys in 2009. All use of systemic antibiotics was registered. The data collection was undertaken according to a protocol developed by the European Surveillance of Antimicrobial Consumption (ESAC) Network and was part of a European study. The nursing homes' drug sales statistics for systemic antibiotics during 2009, distributed by the number of bed days for each nursing home, were estimated. Information on indications for each antibiotic from the prevalence surveys was collated with sales data to achieve an estimate of how the purchased antibiotics were used. RESULTS: The prevalence surveys showed that more than 8% of the residents received antibiotics. Prophylactic treatment accounted for 33% of the prescriptions. A prevalence of antibiotic use of 10% was estimated from the drug sales statistics. Urinary tract infection was the most frequently registered indication. Pivmecillinam and methenamine were most frequently prescribed and most frequently purchased. Most courses of treatment were prescribed in accordance with the national guidelines for antibiotic use. INTERPRETATION: The results from the drug sales statistics concurred well with the prevalence surveys, and the methods can thus be relevant for purposes of monitoring the use of antibiotics.

Antibiotics prophylaxis in connection with caesarean section--guidelines at Norwegian maternity departments.

BACKGROUND: The frequency of caesarean sections is increasing. Infection in operation wounds and/or underlying spaces and organs is a common complication. In Veileder I fødselshjelp [Clinical Guidelines in Obstetrics], 2008, antibiotic prophylaxis is recommended in the form of single dose ampicillin or first generation cephalosporins in connection with acute caesarean sections and under special conditions such as prolonged operations. We wanted to find out whether Norwegian maternity departments follow these recommendations. MATERIAL AND METHODS: All head senior consultants at maternity departments that carried out more than one caesarean section in 2008 were invited to take part in a survey of the department's written guidelines for use of antibiotic prophylaxis in connection with caesarean section. The extent to which the guidelines were followed was evaluated using data from the Norwegian Surveillance System for Hospital-Associated Infections (NOIS). RESULTS: 38 of the 42 maternity wards in the investigation had written guidelines for antibiotic prophylaxis. Four of these maternity wards gave prophylaxis in all Caesarean sections, one only on indication, and 33 in acute Caesarean section. The guidelines varied as regards choice of type of antibiotic and time of administration. In the maternity wards with written guidelines recommending use of antibiotic prophylaxis in all Caesarean sections, were practice in accordance with the guidelines. When the guidelines recommended prophylactic use only in acute operations, there was agreement between practice and guidelines in 71 % to 97 % of the patients in the ward. INTERPRETATION: Most Norwegian maternity wards have written guidelines on antibiotic prophylaxis in Caesarean section. The contents of the guidelines varied but are mainly in agreement with current Norwegian recommendations.

[Infections after Caesarean sections]. / Infeksjoner etter keisersnitt.

BACKGROUND: All hospitals in Norway are required to participate in the Norwegian Surveillance System for Hospital-Acquired Infections (NOIS). Hospitals can choose to have from one to five given surgical procedures under surveillance, caesarean section being one of them. This article describes the incidence of surgical site infections after caesarean sections and identifies causes for such infections. MATERIAL AND METHODS: A national protocol, was developed in accordance with the European protocol (HELICS). Patients undergoing a caesarean section (1 September - 30 November in 2005, 2006 or 2007) in the participating hospitals were included and followed-up for 30 days. Cases were identified in accordance to standardised case definitions. Potential risk factors as well as demographic and clinical data were recorded. RESULTS: 3900 women were included. 290 infections were diagnosed (incidence 8.3 %) among the 3491 women who were followed up after discharge. Only 14 % of the infections were diagnosed during the hospital stay. Age higher than 29 years and contaminated wound class 3 were significantly associated with infection. Among the 54 women with an organ/space or deep infection, 20 were readmitted to the hospital and 11 were reoperated. INTERPRETATION: One of 12 women who undergo a caesarean section develops a surgical site infection. The incidence of infections in Norway is lower than in many other European countries. We recommend hospitals to evaluate the preventive measures implemented at their institution.