Drugs

, Volume 71, Issue 6, pp 745–755 | Cite as

European Surveillance of Antimicrobial Consumption (ESAC)

Value of a Point-Prevalence Survey of Antimicrobial Use Across Europe
Current Opinion

Abstract

All 27 EU member states and another seven countries participate in the European Surveillance of Antimicrobial Consumption (ESAC) project. ESAC carried out three hospital point-prevalence surveys on antimicrobial use. Point-prevalence surveys linked antimicrobial use to indication and also assessed dosing using a standardized methodology for data collection and online data submission with feedback capability using a dedicated web-based tool. The objectives of the ESAC hospital point-prevalence surveys were to first determine the feasibility of a pan-European survey and identify targets for quality improvement.

Hospitals were voluntarily selected by the lead national or hospital representatives for each country. The WHO Anatomical Therapeutic Chemical Classification of drugs was used for classification of antimicrobials. The three surveys were carried out during a maximum of 2 weeks in the second quarter of 2006, 2008 and 2009. Each department had to be surveyed in 1 day. All systemic antibacterials (J01), rifampicin (J04AB), oral vancomycin (A07AA) and oral/rectal metronidazole (P01AB) were the antimicrobials surveyed, including the prescribed regimen.

The number of participating hospitals increased from 20 to 172 from 2006 to 2009. The patient demographics and indications for treatment were similar throughout the three point-prevalence surveys. ‘Reason in notes’ and ‘surgical prophylaxis >24 hours’ were also similar. Guideline compliance (51%) was only introduced in the 2009 point-prevalence survey, replacing ‘sample for culture and sensitivity’ (<50% in 2006 and 2008) since samples were either not taken or no information was available for the majority (>50%) of patients. The use of combination therapy, although exhibiting a wide range within each category, was related to hospital type, with teaching and tertiary hospitals having a significantly higher use of combination therapy (teaching: non-teaching hospitals [p < 0.0001]; and primary: tertiary hospitals [p < 0.0001]).

Point-prevalence surveys are useful when time and resources do not allow for continuous surveillance. Repeated point-prevalence surveys within the same institution(s) can be used to monitor trends and effectiveness of antimicrobial-stewardship initiatives. Targets should be set as quality indicators for the individual hospital(s) and effectiveness of any intervention monitored through repeated point-prevalence surveys. Spin-off initiatives, such as the Antibiotic Resistance and Prescribing in European Children, and the European Centre for Disease Prevention and Control point-prevalence survey on healthcare-associated infections and antimicrobial use, will utilize adapted versions of WebPPS, the point-prevalence survey software developed by ESAC. WebPPS will also be made available for non-commercial use to third parties. Interest has been shown from three continents outside Europe, namely North America, Australia and Africa.

References

  1. 1.
    Zarb P, Amadeo B, Muller A, et al. Identification of targets for quality improvement in antimicrobial prescribing: the web-based ESAC Point Prevalence Survey 2009. J Antimicrob Chemother 2011 Feb; 66(2): 443–9PubMedCrossRefGoogle Scholar
  2. 2.
    Willemsen I, Groenhuijzen A, Bogaers D, et al. Appropriateness of antimicrobial therapy measured by repeated prevalence surveys. Antimicrob Agents Chemother 2007 Mar; 51: 864–7PubMedCrossRefGoogle Scholar
  3. 3.
    Heginbothom M, Howe R. National Public Health Service for Wales report on point prevalence survey of antimicrobial prescribing in secondary care in Wales, 2008 [online]. Available from URL: http://www2.nphs.wales.nhs.uk:8080/WARPDocs.nsf/61c1e930f9121fd080256f2a004937ed/081e10fdd2def1c4802575ed0041b5c3/$FILE/All-Wales%20Antimicrobial%20PPS%202008%20report.pdf [Accessed 2010 Dec 30]
  4. 4.
    ESAC. Report on the point prevalence survey of antimicrobial prescriptions in European hospitals, 2008 [online]. Available from URL: http://www.esac.ua.ac.be/download.aspx?c=*ESAC2&n=50297&ct=50294&e=50480 [Accessed 2010 Dec 30]
  5. 5.
    Ansari F, Erntell M, Goossens H, et al. The European Surveillance of Antimicrobial Consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis 2009 Nov; 49: 1496–504PubMedCrossRefGoogle Scholar
  6. 6.
    Malcolm W, Cromwell T, on behalf of Information Work-stream of Scottish Antimicrobial Prescribing Group (SAPG). European Surveillance of Antimicrobial Consumption point prevalence survey 2009 Scottish Hospitals Report, May 2010 [online]. Available from URL: http://www.scottishmedicines.org.uk/files/ESAC_report_final_060510.pdf [Accessed 2010 Dec 30]
  7. 7.
    Aldeyab M, Kearney M, McElnay J, et al. A point prevalence survey of antibiotic prescriptions: benchmarking and patterns of use. Br J Clin Pharmacol 2011 Feb; 71(2): 293–6PubMedCrossRefGoogle Scholar
  8. 8.
    ESAC. Report on point prevalence survey of antimicrobial prescribing in European hospitals, 2009 [online]. Available from URL: http://www.esac.ua.ac.be/download.aspx?c=*ESAC2&n=50297&ct=50294&e=50483 [Accessed 2010 Dec 30]
  9. 9.
    Amadeo B, Zarb P, Muller A, et al. European surveillance of antibiotic consumption (ESAC) point prevalence survey 2008: paediatric antimicrobial prescribing in 32 hospitals of 21 European countries. J Antimicrob Chemother 2010 Oct; 65: 2247–52PubMedCrossRefGoogle Scholar
  10. 10.
    van de Sande-Bruinsma N, Grundmann H, Verloo D, et al. Antimicrobial drug use and resistance in Europe. Emerg Infect Dis 2008 Nov; 14: 1722–30PubMedCrossRefGoogle Scholar
  11. 11.
    Goossens H, Ferech M, Vander Stichele R, et al. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005 Feb; 365: 579–87PubMedGoogle Scholar
  12. 12.
    Borg MA, Zarb P, Scicluna EA, et al. Antibiotic consumption as a driver for resistance in Staphylococcus aureus and Escherichia coli within a developing region. Am J Infect Control 2010 Apr; 38: 212–6PubMedCrossRefGoogle Scholar
  13. 13.
    Jacoby TS, Kuchenbecker RS, Dos Santos RP, et al. Impact of hospital-wide infection rate, invasive procedures use and antimicrobial consumption on bacterial resistance inside an intensive care unit. J Hosp Infect 2010 May; 75: 23–7PubMedCrossRefGoogle Scholar
  14. 14.
    Goossens H. Antibiotic consumption and link to resistance. Clin Microbiol Infect 2009 Apr; 15 Suppl. 3: 12–5PubMedCrossRefGoogle Scholar
  15. 15.
    Lai CC, Wang CY, Chu CC, et al. Correlation between antimicrobial consumption and resistance among Staphylococcus aureus and enterococci causing healthcare-associated infections at a university hospital in Taiwan from 2000 to 2009. Eur J Clin Microbiol Infect Dis 2011 Feb; 30(2): 265–71PubMedCrossRefGoogle Scholar
  16. 16.
    Metz-Gercek S, Maieron A, Strauss R, et al. Ten years of antibiotic consumption in ambulatory care: trends in prescribing practice and antibiotic resistance in Austria. BMC Infect Dis 2009; 9: 61PubMedCrossRefGoogle Scholar
  17. 17.
    Ansari F, Molana H, Goossens H, et al. Development of standardized methods for analysis of changes in antibacterial use in hospitals from 18 European countries: the European surveillance of antimicrobial consumption (ESAC) longitudinal survey, 2000–06. J Antimicrob Chemother 2010 Dec; 65: 2685–91PubMedCrossRefGoogle Scholar
  18. 18.
    Bronzwaer S, Goettsch W, Olsson-Liljequist B, et al. European Antimicrobial Resistance Surveillance System (EARSS): objectives and organisation. Euro Surveill 1999; 4 (4): pii=66 [online]. Available from URL: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=66 [Accessed 2010 Dec 30]
  19. 19.
    Gruen RL, Chang S, MacLellan DG. The point prevalence of wounds in a teaching hospital. Aust NZ J Surg 1997 Oct; 67: 686–8CrossRefGoogle Scholar
  20. 20.
    Burvill PW, Finlay-Jones RA. A point prevalence study of outpatients and inpatients in the mental health services, general hospital psychiatric units, and under private psychiatrists in Perth, Western Australia. Aust NZ J Psychiatry 1977 Mar; 11: 45–51CrossRefGoogle Scholar
  21. 21.
    Ochoa Calvo P, García-Arilla Calvo E. Inappropriate hospital admission and stay according to the appropriateness evaluation protocol: study of point prevalence in a geriatric department [letter]. Med Clin (Barc) 1997 Jun; 109: 195Google Scholar
  22. 22.
    Starakis I, Marangos M, Gikas A, et al. Repeated point prevalence survey of nosocomial infections in a Greek university hospital. J Chemother 2002 Jun; 14: 272–8PubMedGoogle Scholar
  23. 23.
    Leblebicioglu H, Esen S. Hospital-acquired urinary tract infections in Turkey: a nationwide multicenter point prevalence study. J Hosp Infect 2003 Mar; 53: 207–10PubMedCrossRefGoogle Scholar
  24. 24.
    Balkhy HH, Cunningham G, Chew FK, et al. Hospital- and community-acquired infections: a point prevalence and risk factors survey in a tertiary care center in Saudi Arabia. Int J Infect Dis 2006 Jul; 10: 326–33PubMedCrossRefGoogle Scholar
  25. 25.
    Ritchie S, Jowitt D, Roberts S. The Auckland city hospital device point prevalence survey 2005: utilisation and infectious complications of intravascular and urinary devices. NZ Med J 2007; 120: U2683Google Scholar
  26. 26.
    Faria S, Sodano L, Dauri M, et al. First point prevalence survey of nosocomial infections in the intensive care units of a tertiary care hospital in Albania. J Hosp Infect 2008 May; 69: 95–7PubMedCrossRefGoogle Scholar
  27. 27.
    McKechnie AA. A point prevalence study of a long term hospital population. Health Bull (Edinb) 1972 Oct; 30: 250–8Google Scholar
  28. 28.
    Cooke DM, Salter AJ, Phillips I. The impact of antibiotic policy on prescribing in a London teaching hospital: a one-day prevalence survey as an indicator of antibiotic use. J Antimicrob Chemother 1983 May; 11: 447–53PubMedCrossRefGoogle Scholar
  29. 29.
    Berild D, Ringertz SH, Lelek M. Appropriate antibiotic use according to diagnoses and bacteriological findings: report of 12 point-prevalence studies on antibiotic use in a university hospital. Scand J Infect Dis 2002; 34: 56–60PubMedCrossRefGoogle Scholar
  30. 30.
    Usluer G, Ozgunes I, Leblebicioglu H. A multicenter point-prevalence study: antimicrobial prescription frequencies in hospitalized patients in Turkey. Ann Clin Microbiol Antimicrob 2005; 4: 16PubMedCrossRefGoogle Scholar
  31. 31.
    Ufer M, Radosevic N, Vogt A, et al. Antimicrobial drug use in hospitalised paediatric patients: a cross-national comparison between Germany and Croatia. Pharmacoepidemiol Drug Saf 2005 Oct; 14: 735–9PubMedCrossRefGoogle Scholar
  32. 32.
    Seaton RA, Nathwani D, Burton P, et al. Point prevalence survey of antibiotic use in Scottish hospitals utilising the Glasgow antimicrobial audit tool (GAAT). Int J Antimicrob Agents 2007 Jun; 29: 693–9PubMedCrossRefGoogle Scholar
  33. 33.
    Hajdu A, Samodova OV, Carlsson TR, et al. A point prevalence survey of hospital-acquired infections and antimicrobial use in a paediatric hospital in north-western Russia. J Hosp Infect 2007 Aug; 66: 378–84PubMedCrossRefGoogle Scholar
  34. 34.
    Dimiŋa E, Kūla M, Caune U, et al. Repeated prevalence studies on antibiotic use in Latvia, 2003–2007. Euro Surveill 2009; 14 (33): pii=19307 [online]. Available from URL: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19307 [Accessed 2010 Nov 03]
  35. 35.
    Ciofi Degli Atti ML, Raponi M, Tozzi AE, et al. Point prevalence study of antibiotic use in a paediatric hospital in Italy. Euro Surveill 2008; 13 (41): pii=19003 [online]. Available from URL: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19307 [Accessed 2010 Dec 30]
  36. 36.
    Ang L, Laskar R, Gray JW. A point prevalence study of infection and antimicrobial use at a UK children’s hospital. J Hosp Infect 2008 Apr; 68: 372–4PubMedCrossRefGoogle Scholar
  37. 37.
    Harbarth S, Samore MH, Lichtenberg D, et al. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation 2000 Jun; 101: 2916–21PubMedCrossRefGoogle Scholar
  38. 38.
    Scottish Intercollegiate Guidelines Network (SIGN). Sign 104: antibiotic prophylaxis in surgery. A national clinical guideline (July 2008) [online]. Available from URL: http://www.sign.ac.uk/pdf/sign104.pdf [Accessed 2010 Nov 25]
  39. 39.
    Kuster SP, Ruef C, Bollinger AK, et al. Correlation between case mix index and antibiotic use in hospitals. J Antimicrob Chemother 2008 Oct; 62: 837–42PubMedCrossRefGoogle Scholar
  40. 40.
    Kuster SP, Ruef C, Ledergerber B, et al. Quantitative antibiotic use in hospitals: comparison of measurements, literature review, and recommendations for a standard of reporting. Infection 2008 Dec; 36: 549–59PubMedCrossRefGoogle Scholar
  41. 41.
    Spiegelhalter D. Ranking institutions. J Thorac Cardiovasc Surg 2003 May; 125: 1171–3; author reply 1173PubMedGoogle Scholar
  42. 42.
    Vander Stichele RH, Elseviers MM, Ferech M, et al. Hospital consumption of antibiotics in 15 European countries: results of the ESAC retrospective data collection (1997–2002). J Antimicrob Chemother 2006 Jul; 58: 159–67PubMedCrossRefGoogle Scholar
  43. 43.
    Watson R. A quarter of patients in some European hospitals acquire infections [letter]. BMJ 2010; 341: c6700PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  1. 1.Infection Control UnitMater Dei HospitalMsidaMalta
  2. 2.Laboratory of Medical Microbiology, Vaccine and Infectious Diseases InstituteUniversiteit Antwerpen-Campus Drie EikenAntwerpenBelgium

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