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A nationwide evaluation of antibiotics consumption in Swedish intensive care units

Sjövall, Fredrik LU orcid ; Edström, Morgan ; Walther, Sten LU and Hanberger, Håkan (2022) In Infectious Diseases 54(10). p.713-721
Abstract

Background: Around 70% of all ICU patients are treated with antibiotics whereas up to 30% are suggested as unnecessary. Measuring antibiotic consumption is a prerequisite to improving its use and the purpose of the present investigation was to explore the use of antibiotics in Swedish ICUs. Material and methods: Daily Defined Doses (DDDs) of antimicrobials delivered to Swedish ICUs, 2016–2018, were retrieved from Swedish pharmacies. From the Swedish Intensive Care Registry, we extracted data on a number of patient admissions, occupied bed days and Simplified Acute Physiology Score (SAPS)3. Results: There was a similar annual rate of total DDDs per admission of 3.7, 3.5, 3.8 and total DDDs per 100 occupied bed days of 111, 111, and 115... (More)

Background: Around 70% of all ICU patients are treated with antibiotics whereas up to 30% are suggested as unnecessary. Measuring antibiotic consumption is a prerequisite to improving its use and the purpose of the present investigation was to explore the use of antibiotics in Swedish ICUs. Material and methods: Daily Defined Doses (DDDs) of antimicrobials delivered to Swedish ICUs, 2016–2018, were retrieved from Swedish pharmacies. From the Swedish Intensive Care Registry, we extracted data on a number of patient admissions, occupied bed days and Simplified Acute Physiology Score (SAPS)3. Results: There was a similar annual rate of total DDDs per admission of 3.7, 3.5, 3.8 and total DDDs per 100 occupied bed days of 111, 111, and 115 but with an approximately 6-fold difference of DDDs per occupied bed days (61–366) between the ICUs. The most frequently used antibiotics were isoxazolyl penicillins (J01CF), penicillins with betalactamase-inhibitors, mainly piperacillin/tazobactam (J01CR), 3rd and 4th generation cephalosporins (J01DD + DE) and carbapenems (J01DH). Together these four classes accounted for a median of 52% of all antibiotic use. The use of carbapenems had a moderate positive correlation with the mean SAPS3 score (r = 0.6, p =.01). The use of other broad-spectrum antibiotics showed no such correlation. Conclusion: Overall antibiotic use remained similar in Swedish ICUs during the years 2016–2018. Broad-spectrum antibiotics accounted for 50% of all DDDs but with a large inter-ICU variation which only partly can be explained by differences in patient case mix and microbial resistance. Presumably, it also reflects varying local prescribing practices.

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Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Antibiotics, antimicrobial stewardship, antimicrobials, critical care, intensive care
in
Infectious Diseases
volume
54
issue
10
pages
9 pages
publisher
Taylor & Francis
external identifiers
  • scopus:85135731066
  • pmid:35638173
ISSN
2374-4235
DOI
10.1080/23744235.2022.2081717
language
English
LU publication?
yes
id
2950cf8c-3ce5-4a6b-b68f-6bf8d7063d73
date added to LUP
2022-09-19 11:12:44
date last changed
2025-11-01 15:17:53
@article{2950cf8c-3ce5-4a6b-b68f-6bf8d7063d73,
  abstract     = {{<p>Background: Around 70% of all ICU patients are treated with antibiotics whereas up to 30% are suggested as unnecessary. Measuring antibiotic consumption is a prerequisite to improving its use and the purpose of the present investigation was to explore the use of antibiotics in Swedish ICUs. Material and methods: Daily Defined Doses (DDDs) of antimicrobials delivered to Swedish ICUs, 2016–2018, were retrieved from Swedish pharmacies. From the Swedish Intensive Care Registry, we extracted data on a number of patient admissions, occupied bed days and Simplified Acute Physiology Score (SAPS)3. Results: There was a similar annual rate of total DDDs per admission of 3.7, 3.5, 3.8 and total DDDs per 100 occupied bed days of 111, 111, and 115 but with an approximately 6-fold difference of DDDs per occupied bed days (61–366) between the ICUs. The most frequently used antibiotics were isoxazolyl penicillins (J01CF), penicillins with betalactamase-inhibitors, mainly piperacillin/tazobactam (J01CR), 3rd and 4th generation cephalosporins (J01DD + DE) and carbapenems (J01DH). Together these four classes accounted for a median of 52% of all antibiotic use. The use of carbapenems had a moderate positive correlation with the mean SAPS3 score (r = 0.6, p =.01). The use of other broad-spectrum antibiotics showed no such correlation. Conclusion: Overall antibiotic use remained similar in Swedish ICUs during the years 2016–2018. Broad-spectrum antibiotics accounted for 50% of all DDDs but with a large inter-ICU variation which only partly can be explained by differences in patient case mix and microbial resistance. Presumably, it also reflects varying local prescribing practices.</p>}},
  author       = {{Sjövall, Fredrik and Edström, Morgan and Walther, Sten and Hanberger, Håkan}},
  issn         = {{2374-4235}},
  keywords     = {{Antibiotics; antimicrobial stewardship; antimicrobials; critical care; intensive care}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{713--721}},
  publisher    = {{Taylor & Francis}},
  series       = {{Infectious Diseases}},
  title        = {{A nationwide evaluation of antibiotics consumption in Swedish intensive care units}},
  url          = {{http://dx.doi.org/10.1080/23744235.2022.2081717}},
  doi          = {{10.1080/23744235.2022.2081717}},
  volume       = {{54}},
  year         = {{2022}},
}