BACKGROUND: The digitalization of information systems allows automatic measurement of antimicrobial consumption (AMC), helping address antibiotic resistance from inappropriate drug use without compromising patient safety.
OBJECTIVE: Describe and characterize a new automated AMC surveillance service for intensive care units (ICUs), with data stratified by referral clinic and linked with individual patient risk factors, disease severity, and mortality.
METHODS: An automated service collecting data from the electronic medical record was developed, implemented, and validated in a healthcare region in northern Sweden. We performed an observational study from January 1, 2018, to December 31, 2021, encompassing general ICU care for all ≥18-years-olds in a catchment population of 270000 in secondary care and 900000 in tertiary care. We used descriptive analyses to associate ICU population characteristics with AMC outcomes over time, including days of therapy (DOT), length of therapy, defined daily doses, and mortality.
RESULTS: There were 5608 admissions among 5190 patients with a median age of 65 (IQR 48-75) years, 41.2% females. The 30-day mortality was 18.3%. Total AMC was 1177 DOTs in secondary and 1261 DOTs per 1000 patient days and tertiary care. AMC varied significantly among referral clinics, with the highest total among 810 general surgery admissions in tertiary care at 1486 DOTs per 1000 patient days. Case-mix effects on the AMC were apparent during COVID-19 waves highlighting the need to account for case-mix. Patients exposed to more than three antimicrobial drug classes (N = 242) had a 30-day mortality rate of 40.6%, with significant variability in their expected rates based on admission scores.
CONCLUSIONS: We introduce a new service and instructions for automating local ICU-AMC data collection. The versatile long-term ICU-AMC metrics presented, covering patient factors, referral clinics and mortality outcomes, are expected to be beneficial in refining antimicrobial drug use.

BACKGROUND: Antimicrobial consumption in veterinary medicine is of great importance. Increased awareness by the public and media has led to demands for decreased use of antimicrobials in pigs. This study aimed to identify risk factors for regular oral antimicrobial consumption in Swiss fattening pig farms, and to quantify the amount of antimicrobial active substances administered orally to pigs at the farm level.
RESULTS: A case-control study was performed on 99 fattening farms between May 2014 and January 2015. Seventy-two case farms (with oral group treatment of antimicrobials in at least 50 % of pigs) and 27 control farms (with no regular oral group treatment) were visited once during the study. Data about potential risk factors and antimicrobial consumption were collected by questionnaire. Antimicrobial consumption was recorded and treatment incidence (TI) was calculated for all farms over a one year period. Sulphonamides and tetracyclines were the antimicrobials consumed in the greatest quantity. The median TI for oral antimicrobial use in the case group was 224.7. In the control group, the median TI was 0 for oral antimicrobial use, with values ranging from 0 to 140.1. In a multivariable regression model, seven risk factors associated with regular oral antimicrobial group treatment were identified: mixing pigs from different suppliers within the same pen, absence of a work protocol that ensures treating of healthy pigs before sick pigs, distance to next pig farm < 500 metres, external analysis of production parameters, no availability of dirty visitor boots, the farmer not working on other farms, and no application of homoeopathic agents.
CONCLUSIONS: The results of this study point out the importance of increasing farmers\' awareness of good farming practices and biosecurity. Important recommendations for decreasing oral antimicrobial consumption identified by this study include avoiding mixing pigs from different suppliers in the same pen and strictly handling sick pigs after healthy ones. Improvements in these areas could enhance the overall health of pigs and thereby reduce the consumption of antimicrobials on pig farms.