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Antibiotic Prescribing – Quality Indicators Clinical Microbiology and Infection, Volume 12, Supplement 4, 2006 Antibiotic prescribing – quality indicators P1460 Methods: Medical records from all patients with positive blood Is self-medication with antibiotics in Europe cultures in 2001 were analysed retrospectively. Factors driven by prescribed use? predisposing to infections, results of blood cultures, antibiotic use, and outcome were recorded. L. Grigoryan, F.M. Haaijer-Ruskamp, J.G.M. Burgerhof, Results: The antibiotic use in 226 episodes of true bacteraemia J.E. Degener, R. Deschepper, D. Monnet, A. Di Matteo, were analysed. According to guidelines empirical antibiotic ˚ and the SAR E.A. Scicluna, A. Bara, C. Stalsby Lundborg, J. Birkin treatment should be adjusted in 166 episodes. Antibiotic use was group adjusted in 146 (88%) of these 166 episodes, which led to a Objectives: The occurrence of self-medication with antibiotics narrowing of therapy in 118 (80%) episodes. Compared to has been described in the US and Europe, a possible empirical therapy there was a 22% reduction in the number of contributing factor to increased antibiotic resistance. An antibiotics. Adjustment of therapy was more often performed in important reason for using self-medication can be past Gram-negative bacteraemia and polymicrobial cultures than in experience with antibiotics prescribed by health professionals. Gram-positive bacteraemia. In bacteraemia caused by We investigated whether self-medication in Europe follows the ampicillin-resistant E. coli, ampicillin was mostly replaced by same pattern as prescribed use. ciprofloxacin. The cost for 7 days adjusted therapy was 19800 Methods: A population survey was conducted in: North and EUR (23%) less than for 7 days of empirical therapy. West of Europe (DK, AT, NL, SE, BE, UK, IE and LU), South (IT, MT, IL and ES) and East (SK, LT, CZ, HR, PL, RO and SL) with a self-administered postal questionnaire. A total of 15548 people completed the questionnaires. Using a multistage sampling design, we selected in each country a random sample of 1000– 3000 adults equally distributed in urban and rural areas. The analyses were done on the individual level using multivariate logistic regression analysis. We tested possible interactions between the factors found to be significant. Results: The use of prescribed antibiotics was independently associated with self-medication in the previous 12 months. A significant interaction was found between prescribed use and regions in Europe: the effect of prescribed use was the largest in North and West (odds ratio 7.6 95% CI 4.2–13.6) and smaller in South (OR 2.1, 1.2–3.7) and East (1.9, 1.3–2.7). When studying the association between prescribed use and self-medication for a specific symptom/disease or specific antibiotic strong associations were found. For example, respondents who used prescribed antibiotics for a throat symptom had 7.1 times (4.4–11.4) higher Conclusion: Adjustment of antibiotic use according to results of probability for self-medication for a throat symptom. For the other blood cultures led to improvement of antibiotic use and symptoms the odds ratios varied from 6.4 to 7.7. Prescribed use and decreased costs. actual self-medication were both significant predictors of intended self-medication. We found a significant interaction, indicating that P1462 prescribed use increased the risk of intended self-medication in those respondents who did not use actual self-medication. Impact of an active surveillance system on Respondents who used prescribed antibiotics for a specific antimicrobial use and resistance in a symptom in the previous 12 months had 1.7–7.1 times higher neurosurgical intensive care unit probability of intended self-medication for the same symptom. E. Meyer, J. Buttler, F. Schwab, E. Strehl, P. Gastmeier, H. Ruden, Conclusion: Self-medication with antibiotics in Europe is K. de With, J. Zentner, F. Daschner (Freiburg, Berlin, Hannover, associated with prescribed use and may even be driven by it. DE) Routine prescribing of antibiotics for minor ailments such as cold symptoms increases the risk of self-medication with Objective: To analyse the impact of SARI (Surveillance of antibiotics for such ailments. Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units) on antibiotic use, resistance, device associated infection rates (NI) and costs in a neurosurgical university ICU. P1461 Methods: Comparison of prospective unit and laboratory based Adjustment of antibiotic treatment according to surveillance data of 40 German ICUs from 2000–2004 with the the results of blood cultures leads to decreased study ICU. Antimicrobial consumption is calculated by WHO antibiotic use and costs defined daily doses (DDD) per 1000 patient days (AD). NIs are reported according to CDC definitions. Benchmarking data were D. Berild, A. Mohseni, L.M. Diep, M. Jensenius, fed back to the study ICU and analysed there in a multidisci- S.H. Ringertz (Oslo, NO) plinary team every three months between 2000 and 2003 and Objective: To investigate whether the results of blood cultures every 6 months since 2004. led to changes in antibiotic use and costs in a university hospital Results: In the study a total of 1,004 SARI isolates were in Norway reported; this figure corresponds to 72.0 isolates/1000 pd. 2006 Clinical Microbiology and Infection, Volume 12, Supplement 4 ISSN: 1470-9465 Abstracts Resistance rates (RR) over a period of 5 years were generally P1464 better than those reported for a total of 40 ICUs. The mean MRSA RR was 22.1%, for all the SARI ICUs, whereas it was only Decreasing outpatient antibiotic prescribing in 2.7% in the study ICU. By the end of 2003 duration of treatment Germany, 1995–2004, does not include newer for pneumonia had been reduced to 5–7 days and written macrolides, fluoroquinolones and extended- guidelines on empiric antibiotic treatment and prophylaxis were spectrum beta-lactams revised with respect to the resistance situation of the study ICU. W.V. Kern, K. de With, K. Nink, H. Schro¨der (Freiburg, Bonn, The significant decrease between 2000 and 2004 in total DE) antimicrobial AD from 1,099 to 607 in the study ICU resulted mainly from the reduced consumption of 2nd generation Objective: The ESAC (European Surveillance of Antibiotic cephalosporins, carbapenems and imidazoles. NI did not Consumption, www.ua.ac.be/ESAC) project has shown that change significantly over time. Compared to the year 2000, the outpatient antibiotic prescribing in Germany has been costs for antibiotics were halved from €51,102 to 22,324, which comparatively low among European countries. We assessed corresponds to €18.7/pd and €6.6/pd, respectively. The per- trends over time and regional variation of outpatient antibiotic centage of antibiotics in the total ICU budget for pharmaceuti- use in Germany, and wondered if the observable decreasing cals decreased from 14.6% to 10.4%. trend included all drug classes to a similar extent. Conclusion: Surveillance and feedback of antibiotic use and Methods: Prescription data (compulsory health insurance resistance can serve as a valuable quality control instrument and covering >90% of the population, sample of 0.4% until the can have an impact on antibiotic treatment. From 2000 to 2004, year 2000, all prescriptions thereafter) were analysed using the antibiotic use was reduced by 45% and costs for antibiotics/pd ATC/WHO methodology and current DDD definitions. We were cut by two third in the ICU study without any increase in specifically defined the following drug groups: ‘‘basic’’ device associated nosocomial infection rates. The resistance penicillins (BPENs, oral penicillin or aminopenicillins), situation was generally better than in all SARI ICUs, but showed extended-spectrum betalactams (ESBLs, oral cephalosporins, heavy fluctuations. staphylococcal penicillins, aminopenicillin/betalactamse inhibitor combinations, parenteral cephalosporins and broad- spectrum betalactams), newer macrolides (NMLs, P1463 roxithromycin, clarithromycin, azithromycin) versus older Similar illness burden but different antibiotic macrolides (OMLs). Quinolones (FQs), folate synthesis inhibitors (T/Ss) and tetracyclines (TETs) were also assessed. prescription to children: a population-based Data were expressed in yearly DDD/1000 persons covered by study the insurance (DDD/1000). K. Hedin, M. Andre, A. Ha˚kansson, N. Rodhe, S. Mo¨lstad, Findings: Outpatient prescribing in 1995 was 6140 DDD/1000 C. Petersson (Va¨xjo¨, Falun, Malmo¨, Linko¨ping, SE) (corresponding to 16.8 DID = DDD/1000 and day) and decreased to 5430 DDD/1000 in the year 2000 and to 4672 Objectives: Respiratory tract infections are the most common DDD/1000 in 2004. The decreasing trend over the last 4 years reason for antibiotic prescription in Sweden as in other was observed in all regions. The decrease was most significant countries. The prescription rates vary markedly in different for OMLs ()55%), T/Ss ()48%), TETs ()36%), and BPENs countries, counties and municipalities. The reasons for these ()13%) while there was no decreasing use of ESBLs (±0%) and variations in prescription rates are not obvious. The aim of the increases in the rate of prescribing NMLs (+13%) and FQs study was to find possible explanations for different antibiotic (+43%). TETs and BPENs, however remained the most prescription rates in children. Therefore a prospective prescribed antibiotics in 2004. Regional variations in 2004 population based log book study was conducted in four remained large for BPENs (>3-fold) with very low prescribing municipalities which, according to official statistics, had high rates in the Eastern region, but were small for T/Ss, NMLs and and three municipalities which had low antibiotic prescription FQs (<2-fold). rates. Conclusions: Over a decade we observed a 24% decreasing Methods: During one month, parents recorded all infectious outpatient antibiotic prescribing that included relevant symptoms, physician consultations and antibiotic treatments, antibiotic drug classes except ESBLs, NMLs and FQs. The from 848 18-month-old children in a log book. The children’s relative increase was most significant for FQs. parents also answered a questionnaire about socioeconomic factors and concern about infectious illness.
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