1. Erntell M, Skoog G, Cars O, Eriksson M, Skärlund K, Elowson S, Hanberger H, Odenholt I, Prag M, Struwe J, Torell E, Ulleryd P. STRAMA, Swedish Institute for Infectious Disease Control, S-171 82 Solna, Sweden POINT PREVALENCE STUDY OF ANTIBIOTIC USE IN HOSPITALISED PEDIATRIC PATIENTS IN SWEDEN Introduction and purpose Data revealing antibiotic consumption and prescription patterns related to diagnose at the patient level is essential in finding ways to optimize antibiotic use in the hospital setting. We present data on pediatric patients from the first nation wide point prevalence study, PPS, performed in Sweden. Methods The study was performed within a two-week period in November 2003 by the local STRAMA-groups using a web-based reporting system. Each department had one personal visit of an experienced doctor collecting data. The protocol was designed to present demographic data as well as the amounts and indications for antimicrobial agents against bacteria and fungi. Treatments were recorded in relation to diagnose and the therapeutic indication as either prophylactic use or treatment of community acquired (CAI) and hospital acquired infection (HAI). 19 pre-defined diagnosis groups were used. Children were defined as patients 0-16 years old. Results 28 out of 54 hospitals participating in the main study recorded data on 913 admitted children. Four pediatric departments at university hospitals included nearly 50% of the patients. E-mail: gunilla.skoog@smi.ki.segunilla.skoog@smi.ki.se mats.erntell@lthalland.se 266 included children (141 girls, 125 boys) 279 different therapies were recorded; 251 in departments of pediatrics (28%) 28 in wards for adults 29% were related to immunosuppression and foreign material infections. Cultures were taken before oral treatment in 68% and before parenteral treatment in 73%. The distribution of diagnosis groups and therapy reasons in treated children: The antimicrobials used in 258 treatments for CAI and HAI were: Antimicrobials used for treatment of three community acquired infections (CAI): Antimicrobials used in 47 septicaemia treatments: The length of peri-operative prophylaxis was too long, >1 day, in 59% of all therapies. 86% of all treatments were assessed as adequate. Conclusions The PPS method was successfully introduced resulting in one of the largest surveys in Europe of antimicrobial hospital treatments in children. 86% of treatments were adequate Peri-operative prophylaxis was too long, >1 day in 59% of therapies The HAI prevalens was 7% Cephalosporins are over-used in community acquired infections as pneumonia and skin and soft tissue infections 29% of the therapies were complicated by immunosuppression and/or foreign material Cultures were taken in 68% before oral treatment and 73% before parenteral treatment Abstract Objectives: The objective of the study was to introduce a nation wide survey system for frequent assessment of the use of antimicrobial agents in relation to diagnose. The STRAMA-groups have performed the first point prevalence study, PPS, using a web-based reporting system. Method: A nation wide PPS with one personal visit to each department was performed within a two-week period in November 2003. The protocol was designed to present demographic data as well as the amounts and indications for antimicrobial agents against bacteria and fungi. Treatments were recorded in relation to diagnoses and prophylactic use, community acquired (CAI) and hospital acquired infection (HAI). 19 pre- defined diagnosis groups were used. Children were identified as patients 0-16 years old. Results: 28 out of the 54 participating hospitals in the main study recorded data for children. Four pediatric departments at university hospitals included nearly 50% of the patients. 266 children (125 girls, 141 boys) were treated with antimicrobial agents and 27 of them were admitted to wards for adults. The children were given 279 different therapies and 29% of these were related to immunosuppression and foreign material or both. In departments of pediatrics 252 (28%) patients were treated with antimicrobials. The distribution of the 279 therapies was; community acquired infections in 52%, hospital-acquired infections in 23% and prophylaxis in 25%. The most common diagnose groups were; primary septicaemia 47 (17%), pulmonary infections 42 (15%), upper urinary tract infection 26 (9%), lower gastrointestinal tract 25 (9%) and skin and soft tissue infections 24 (9%). 340 different antimicrobials were used, 258 for treatment and 82 for prophylaxis. The most commonly used antimicrobials were: in treatment, cephalosporins 106 (41%), beta-lactamase sensitive penicillins 22 (9 %), tienamycins 19 (7%), glycopeptides 17 (7%). In prophylaxis, the order of use was cephalosporins 25 (30%), co-trimoxazole 13 (16%), beta-lactamase resistant penicillins 12 (15%) and beta-lactamase sensitive penicillins 6 (7%). More than 90% of treatments were assessed as adequate. The length of prophylaxis was too long, more than one day, in nearly 50% of al perioperative prophylactic treatments. Conclusions: The PPS method was successfully introduced resulting in one of the largest surveys in Europe of antimicrobial hospital treatments in children. The study indicates that hospitalised children in Sweden are treated for serious infections. But still, the use of cephalosporins is too predominating. Perioperative prophylaxis is too long, as in adults. Diagnose groups Central nervous system Ophthalmic infections Mouth and throat Upper respiratory tract Bronchitis Pulmonary infections Cardiovascular system Upper gastrointestinal tract Lower gastrointestinal tract Infectious gastrointestinal diseases Liver/bile duct/pancreas/spleen Skin and soft tissue Bone and joint Lower urinary tract infection Upper urinary tract infection Genital infections Septicaemia, primary Un-specified indication, fever Indication unclear Antimicrobials used in 82 therapies as prophylaxis (%): peri-operative (49) medical (33) Cephalosporins 49 12 Isoxa-pc 22 3 Nitroimidazoles 12 3 Beta-lact sens pc 4 12 Co-trimoxazole 2 36 Trimetoprim 2 12 The therapy reason for treatment was: CAI in 52%, 14% of all admitted HAI in 23%, 7% of all admitted Prophylaxis in 25%, 7% of all admitted