Antibiotic consumption and antibiotic stewardship in Swedish hospitals

Abstract

Background: The aim of this paper was to describe and analyze the effect of antibiotic policy changes on antibiotic consumption in Swedish hospitals and to review antibiotic stewardship in Swedish hospitals.

Results: The main findings were: 1) Antibiotic consumption has significantly increased in Swedish hospitals over the last decade. The consumption of cephalosporins has decreased, whereas that of most other drugs including piperacillin-tazobactam, carbapenems, and penicillinase-sensitive and -resistant penicillins has increased and replaced cephalosporins. 2) Invasive infections caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae have increased, but the proportion of pathogens resistant to third-generation cephalosporins causing invasive infections is still very low in a European and international perspective. Furthermore, the following gaps in knowledge were identified: 1) lack of national, regional, and local data on the incidence of antibiotic resistance among bacteria causing hospital-acquired infections e.g. bloodstream infections and hospital-acquired pneumonia-data on which standard treatment guidelines should be based; 2) lack of data on the incidence of Clostridium difficile infections and the effect of change of antibiotic policies on the incidence of C. difficile infections and infections caused by antibiotic-resistant pathogens; and 3) lack of prospective surveillance programs regarding appropriate antibiotic treatment, including selection of optimal antimicrobial drug regimens, dosage, duration of therapy, and adverse ecological effects such as increases in C. difficile infections and emergence of antibiotic-resistant pathogens.

Conclusions: Evidence-based actions to improve antibiotic use and to slow down the problem of antibiotic resistance need to be strengthened. The effect of such actions should be analyzed, and standard treatment guidelines should be continuously updated at national, regional, and local levels.

Keywords: Antibiotic consumption; antibiotic resistance; antibiotic treatment guidelines.

Figure 1.

Antibiotic groups often used in hospital care in Sweden 2000–2013. DDD/1000 inhabitants and day. Data source: Concise, hospital care and the Swedish eHealth Agency.

Figure 2.

Antibiotic resistance among bacteremic isolates of E. coli and S. aureus from patients admitted to the Karolinska University Hospital, Stockholm 2006–2013.

Figure 3.

E. coli (third-generation cephalosporins; 3GCR) and S. aureus (MRSA) resistance according to EARS-Net surveillance data on invasive infections. Trend lines are shown for Sweden (SWE) compared with the EU average excluding Nordic countries (EU).

Figure 4.

PCR ribotyping of C. difficile isolates collected from Swedish clinical microbiology laboratories during weeks 11 and 39, 2013. (Thomas Åkerlund, Department of Public Health, Sweden).