Benchmarking antimicrobial drug use at university hospitals in five European countries.

A point-prevalence survey of five European university hospitals was performed to benchmark antimicrobial drug use in order to identify potential problem areas in prescribing practice and to aid in establishing appropriate and attainable goals. All inpatients at the university hospitals of Rijeka (Croatia), Tartu (Estonia), Riga (Latvia), Vilnius (Lithuania) and Karolinska-Huddinge (Sweden) were surveyed for antimicrobial drug use during a single day. The frequency of antimicrobial drug use was 24% in Rijeka, 30% in Tartu, 26% in Riga, 14% in Vilnius and 32% in Huddinge. Surgical patients were treated with antimicrobial agents more often than medical patients in Riga (53% vs. 31%), Tartu (39% vs. 26%) and Vilnius (54% vs. 25%). Two-thirds of patients in Rijeka, Tartu, Riga and Vilnius, and fewer than half of the patients in Huddinge, received antimicrobial agents intravenously. Broad-spectrum antimicrobial agents were used most commonly in Rijeka. The prevalence of nosocomial infections treated with antibiotics was 9% at Huddinge, and 3-5% at the other centres. Benchmarking antimicrobial drug use at five university hospitals identified differences and problem areas. The high rates of intravenous administration, poor compliance with guidelines, and prolonged surgical prophylaxis were general problems that deserved specific attention at all centres. A change in prescription practices may reduce unnecessary drug use and decrease antimicrobial resistance.

Differences in antibiotic prescribing in three university hospitals in the Baltic region revealed by a simple protocol for quality assessment of therapeutic indications.

OBJECTIVE: To identify inexpensive and simple quality parameters for the surveillance of antibiotic use in hospital settings. METHODS: A modified point-prevalence study was conducted in three university hospitals in Huddinge, Sweden, Riga, Latvia, and Vilnius, Lithuania. Each ward was visited once during May in the year 2002. All patients receiving antibiotics were identified and their medical records were reviewed by the authors according to the same protocol. Only data from corresponding departments were evaluated and compared. RESULTS: The prevalence of antibiotic use was 35%, 25% and 24% in Huddinge, Riga and Vilnius, respectively. Almost 2/3 of antibiotics were prescribed for treatment and 1/3 for either surgical or medical prophylaxis. Parenteral administration was significantly more common in Riga and Vilnius than in Huddinge. The most commonly prescribed antibiotics were cephalosporins and fluoroquinolones. Prescription of antibiotics for different diagnoses showed large variation between and within hospitals. The first or second generation cephalosporins were prescribed in most cases of surgical prophylaxis. The duration of surgical prophylaxis exceeded one day in 57%, 63% and 87% of cases in Huddinge, Riga and Vilnius, respectively. All antibiotics in Huddinge, and all except five in Riga were supplied by the hospital pharmacy. Antibiotics bought by patients and donated made up 41% of prescribed antibiotics in Vilnius. CONCLUSION: This point-prevalence survey using a simple and inexpensive method for benchmarking demonstrated quantitative and qualitative differences in the use of antibiotics between three university hospitals in the Baltic region, differences that now calls for explanations to their rationality. We suggest that the choice of an antibiotic, rates of intravenously administered treatment and duration of surgical prophylaxis are examples of suitable indicators of rational antibiotic use within a hospital but that comparison of such rates between hospitals is less meaningful.

Healthcare associated infections in university hospitals in Latvia, Lithuania and Sweden: a simple protocol for quality assessment.

Surveillance of healthcare associated infections is an overlooked parameter of good clinical practice in most healthcare institutions, due to the workload demanded in the absence of adequate IT-systems. The aim of the present study was to investigate whether a simple protocol could be used to estimate the burden of healthcare associated infections in three university hospitals in Huddinge in Sweden, Riga in Latvia and Vilnius in Lithuania and form the basis for initiating a long term follow up system. The medical records of all patients receiving antibiotics were reviewed according to a standardised protocol, focusing on the indications for the drugs and on the frequency of hospital acquired infection (HAI) in a point-prevalence survey. Only comparable specialties were included. The proportion of patients treated with antibiotics (prophylaxis not included) were 63/280 (22%) in Huddinge, 73/649 (11%) in Riga and 99/682 (15%) in Vilnius. The proportion of admitted patients treated for a HAI were 15%, 3% and 4%, respectively, (both comparisons Huddinge versus other centres P <0.001). Surgical site infections were most common, followed by infections with an onset more than 2 days after admission without any of the other registered risk factors present. Our inexpensive and simple method showed that healthcare associated infections were a significant problem among patients admitted to Huddinge. The figures obtained can be used for further discussion and form a baseline for follow up at the local level. The comparison of figures between centres was far less relevant than the process the study created.

Healthcare associated infections in university hospitals in Latvia, Lithuania and Sweden: a simple protocol for quality assessment.

Surveillance of healthcare associated infections is an overlooked parameter of good clinical practice in most healthcare institutions, due to the workload demanded in the absence of adequate IT-systems. The aim of the present study was to investigate whether a simple protocol could be used to estimate the burden of healthcare associated infections in three university hospitals in Huddinge in Sweden, Riga in Latvia and Vilnius in Lithuania and form the basis for initiating a long term follow up system. The medical records of all patients receiving antibiotics were reviewed according to a standardised protocol, focusing on the indications for the drugs and on the frequency of hospital acquired infection (HAI) in a point-prevalence survey. Only comparable specialities were included. The proportion of patients treated with antibiotics (prophylaxis not included) were 63/280 (22%) in Huddinge, 73/649 (11%) in Riga and 99/682 (15%) in Vilnius. The proportion of admitted patients treated for a HAI were 15%, 3% and 4%, respectively, (both comparisons Huddinge versus other centres P<0.001). Surgical site infections were most common, followed by infections with an onset more than 2 days after admission without any of the other registered risk factors present. Our inexpensive and simple method showed that healthcare associated infections were a significant problem among patients admitted to Huddinge. The figures obtained can be used for further discussion and form a baseline for follow up at the local level. The comparison of figures between centres was far less relevant than the process the study created.

Marked differences in antibiotic use and resistance between university hospitals in Vilnius, Lithuania, and Huddinge, Sweden.

Antibiotic use and antimicrobial resistance was compared between Vilnius and Huddinge University hospitals. Drug use data were expressed in number of defined daily doses/100 bed-days; antimicrobial resistance were given as percentages of resistant isolates. Thirty-five and 48 different antibiotic drugs were used in Vilnius and Huddinge, respectively. The overall consumption of antibiotics was 15 DDD/100 bed-days in Vilnius and 43 DDD/100 bed-days in Huddinge. Benzylpenicillin, ampicillin, and aminoglycosides were the major antibiotics in Vilnius; beta-lactamase-resistant penicillins, cefalosporins, and quinolones in Huddinge. In Vilnius, gentamicin made up one-quarter of the use. Staphylococcus aureus and Gram-negative isolates from wounds and blood were more resistant to gentamicin in Vilnius. S. aureus was more often methicillin resistant in Vilnius than in Huddinge. There was no S. aureus-resistant to vancomycin in either hospital. The vancomycin-resistant enterococci made up from 4% to 10% in Vilnius hospital, but they were not detected in Huddinge hospital (0%). The majority of Streptococcus pneumoniae isolates were sensitive to benzylpenicillin in both hospitals. The higher resistance of microorganisms to some antibiotics in Vilnius may be explained by heavy use of few antibiotics. Lower level of hygiene procedures, sampling bias, and other methodological issues may also have contributed. Guidelines for antibiotic use and hygienic procedures are now under development in Vilnius.

Changes in the use of antibacterial drugs in the countries of central and eastern Europe.

Use of systemic antibacterial drugs in the countries of central and eastern Europe (CCEE) has been studied using the defined daily doses (DDD) methodology. For the comparison, national wholesale data from Bulgaria, the Czech Republic, Estonia, Hungary, Lithuania, Slovakia, Slovenia and Romania for the years 1989 and 1992 were used, i.e. for the years before and after the rapid sociopolitical changes in these countries. Substantial differences in the patterns of antibacterial drug use between countries as geographically and economically similar as the CCEE were observed. The general sales of antibiotics varied almost twofold among the CCEE and had decreased in most of the CCEE during the study period. The proportion of tetracyclines in the sales of 1992 ranged from 10% in Slovenia to 49% in Estonia, and that of broad-spectrum penicillins from 6% in Estonia to 40% in Slovenia. The use of narrow-spectrum penicillins varied within the range of 4% in Bulgaria to 38% in Slovakia, and had decreased during the study years in all countries. Aminoglycosides accounted for 5-12% of all antibacterials in Bulgaria, Estonia, Lithuania, Romania and Slovakia in the study period, and these countries, with the exception of Slovakia, also had a high consumption of chloramphenicol. In 1992, by far the most popular antiinfectives in the CCEE were doxycycline, ampicillin and co-trimoxazole, which ranked among the top ten drugs in all countries studied.(ABSTRACT TRUNCATED AT 250 WORDS)