Transcript Document

Trends in Antimicrobial
Consumption and Resistance
in Europe and the
First Annual Antibiotic Day
Herman Goossens
University of Antwerp, Belgium
Vice-Chair Belgian Antibiotic Policy Coordination Committee (BAPCOC)
Co-ordinator of ESAC
Chair Technical Advisory Group ECDC EU Antibiotic Day
We made great progress in Europe
since ... October 18, 2001.
Outline of Presentation

Antibiotic resistance in Europe (EARSS)

Antibiotic consumption in Europe (ESAC)

Link between use and resistance
•
At population level
•
At individual level

Strategies to curb resistance in Belgium

EU Antibiotic Day

Conclusions
“If you cannot
measure it,
you cannot
improve it”
Lord Kelvin, 1824-1907
EARSS Participating countries: 31
27 EU Member States
1 Applicant countries
Turkey
3 Other countries
Iceland,
Israel,
Norway
Methicillin-Resistant Staph. aureus in Europe, 2006
0%
Country code (average number of isolates reported per year)
TR (782)
RO (47)
CY (57)
MT (84)
DE (1040)
ES (2816)
PT (754)
IL (862)
IT (826)
HU (723)
BG (155)
CZ (1809)
AT (1336)
IE (1184)
PL (153)
UK (1879)
LU (191)
BE (1118)
HR (527)
SI (526)
GR (950)
FR (4610)
NL (2140)
IS (99)
40%
FI (1543)
45%
SE (2904)
50%
EE (116)
NO (1117)
% fluoroquinolone resistance
Fluoroquinlone-Resistant E.coli in Europe, 2001-2006
2001
2002
2003
2004
2005
2006
35%
30%
25%
20%
15%
10%
5%
Outline of Presentation

Antibiotic resistance in Europe (EARSS)

Antibiotic consumption in Europe (ESAC)

Link between use and resistance
•
At population level
•
At individual level

Strategies to curb resistance in Belgium

EU Antibiotic Day

Conclusions
ESAC Participating countries: 34
27 EU Member States
2 Applicant countries
Croatia,
Turkey
5 Other countries
Former Republic of Macedonia,
Iceland,
Israel,
Norway,
Russia,
Switzerland
Total Outpatient Antibiotic Use in 25
European Countries in 2006
(on-going validation for some countries)
35
30
Ot her J01 classes
Sulf onam ides and t rim et hoprim (J01E)
Quinolones ant ibact erials
(J01M)
Macrolides, lincodam ides and
st rept ogram ins (J01F)
Tet racy clines (J01A)
Ot her bet a-lact am ant ibact erials (J01D)
Bet a-lact am ant ibact erials,
penicillins (J01C)
20
15
10
5
Russian Fed.
Nether lands
Austr ia
Slov enia
Denm ar k
Nor way
Czech Rep.
Sweden
Hungar y
Bulgar ia*
Finland
Lithuania*
Spain* *
Iceland
Cr oatia
Ir eland
Isr ael
Slov akia
Por tugal
Lux em bour g
Belgium
Italy
Fr ance
Cy pr us*
0
Gr eece*
DDD p er 1 0 0 0 in h . p er d ay
25
* Greece, Cyprus, Lithuania, Bulgaria: total care, i.e. hospital and primary care combined.
** Spain: reimbursement data, which do not include over-the-counter sales without a prescription.
Regional Variation of Outpatient
Antibiotic Use in Italy
Total use in DID
35
30
25
20
15
J01X
J01R
J01M
J01G
J01F
J01E
10
J01D
5
J01C
J01B
0
o
a
a
a
a
a
a
a
e
a
a
o
y
o
ni cilia bri gli zzo ata lise br i azi Ital rch an gn rdi nte u ri gn et sta ent iu lia ano
a
n
o
o
p Si a la Pu bru ilic Mo m
L
a
G olz
sc ma ba em Lig rde Ve 'A t.Tr
s
U
m
o
M
d
a
m
i
a
C
i
A Ba
a
T Ro o
u
.B
P
S
C
L
lle v.A nez ut
a
a
ili
V ro Ve v.A
m
P li
ro
E
P
iu
r
F
J01A
Regional Variation of Outpatient
Antibiotic Use in Germany
ESAC Longitudinal Survey in 18 Hospitals in Europe:
Total, Parenteral and Oral Use of Antibacterials in 2005
150
DDD/100 bed-days
Parenteral
Oral
100
50
0
5
17
15
4
14
16
2
20
3
18
Hospital
7
11
10
9
13
1
19
8
6
Prophylaxis one dose
Prophylaxis one day
Prophylaxis >1 day
=1
3
y,
To
ta
l,
N
=5
00
=3
2
N=
71
N=
57
N=
92
st
et
ric
s,
N
gy
na
ec
ol
og
og
y,
ic
s,
ge
ry
,N
=3
1
ur
ol
ob
=1
4
N=
12
ry
,N
su
rg
er
y,
N
op
ae
d
or
th
=1
3
N=
16
0
er
y,
su
rg
ar
su
r
ra
ci
c
as
tic
va
sc
ul
th
o
pl
os
ur
ge
ge
ry
,
su
rg
er
y,
N
su
r
ne
ur
ge
ne
ra
l
ca
rd
ia
c
Per cent of therapies
ESAC Point Prevalence Survey in 20 Hospitals in Europe:
Length of Pre-operative Prophylaxis in Surgery
90,0
80,0
70,0
60,0
50,0
40,0
30,0
20,0
10,0
0,0
Outline of Presentation

Antibiotic resistance in Europe (EARSS)

Antibiotic consumption in Europe (ESAC)

Link between use and resistance
•
At population level
•
At individual level

Strategies to curb resistance in Belgium

EU Antibiotic Day

Conclusions
Correlation Between Macrolide Use and
Macrolide-Resistant Strept. pneumoniae
60
FR
50
ESBE
40
GR
IT
30
LU
DE
20
PT
FI
10
IE
UK
AT
SE
NL NO
DK
0
0
1
2
3
4
5
6
Consumption of macrolides (J01FA) in DID, AC 1998
Organism
year of isolation
[source of
information]
Antibiotic
resistance
Antibiotic use ATC group
(year of data)
No. of
countries
Erythromycin
Macrolides - J01FA
(1998)
16
S. pneumoniae
1999/2000
[8]
Spearman
correlation (r)
(confidence
interval)
0.83
(0.67-0.94)
P-value
< 0.001
Goossens et al, Lancet 2005
Effect of Macrolide versus Placebo Use on Temporal Changes of
Proportion of Macrolide-Resistant Oral Streptococci
•
Mean preantibiotic
carriage of Mac-R
streptococci was
28%
•
Use of both Clar
and Azi resulted in
a huge increase in
resistant
streptococci which
persisted for at
least 6 months (P 
0.01)
•
Macrolide use is
the single most
important driver
for the emergence
of macrolide
resistance
Malhotra et al, Lancet 2007
Outline of Presentation

Antibiotic resistance in Europe (EARSS)

Antibiotic consumption in Europe (ESAC)

Link between use and resistance
•
At population level
•
At individual level

Strategies to curb resistance in Belgium

EU Antibiotic Day

Conclusions
Belgium: a Federal Country...
Strategies to Curb
Resistance in Belgium

Seven multimedia campaigns to promote the prudent
use of antibiotics in outpatients

Two national campaigns to promote hand hygiene in
hospitals

Antibiotic management teams in ALL Belgian hospitals

Several practice guidelines

Antibiotic guide for ambulatory care

Improve infection control practices (better financing
and clear organisation)

Finance surveillance programmes on antibiotic use and
resistance in humans and animals
Belgium Media Campaigns:
Switch from Threat to Negative Message
First 3 campaigns (2000–2003) Latter campaigns (2004 - 2008)

Actors: Ad hoc Working Group
and “Question Santé/Omtrent
Gezondheid”

Approach: Inform the public in
general on the use and misuse
of antibiotics and on the risk of
bacterial resistance

Slogan: ”Use antibiotics less
frequently but better”

Actors: Ad hoc Working Group
and Social Marketing agency
(Duval Guillaume, Antwerp)

Approach: Tackle directly the
hot spots of unjustified
antibiotic treatment: viral
respiratory tract infections

Slogan: “Antibiotics don’t work
against acute bronchitis, flu
and common colds”
Belgium
www.antibiotics-info.be
1999 - 2003
> 2004
Outpatient Antibiotic Use in Belgium
Packages per 1,000 inhabitants per day
1997 – 2006, July to June
4
-1.0%
-3.4%
-3 2 %
-6.4%
3.5
-9.1%
-6.9%
3
Other J01 classes
-7.5%
Verpakkingen per 1,000 inwoners per dag
Packages per 1000 inh. per day
-3.8%
-3.6%
Sulfonamides and trimethoprim (J01E)
2.5
Quinolones (J01M)
Macrolides, lincosamides
2
and streptogramins (J01F)
Tetracyclines (J01A)
Cephalosporins and other
1.5
beta-lactams (J01D)
Penicillins (J01C)
1
0.5
0
97-98
98-99
99-00
00-01
01-02
02-03
03-04
04-05
05-06
Antibiotic Resistance of S.
pneumoniae in Belgium. 1985 - 2007
40
peniG
tetra
erythro
ofloxacine
35
Percentage
30
25
20
15
10
5
0
85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 1
2
3
4
5
6
7
Year
National Reference Centre S. pneumoniae (University of Leuven)
Antibiotic Resistance of Throat Isolates
of S. pyogenes in Belgium. 2002 – 2007
erythromycin
18
16
14
percentage
12
10
8
6
4
2
0
2002
2003
2004
2005
2006
2007
year
National Reference Centre S. pyogenes (University of Antwerp)
Outpatient Antibiotic Use in EUR,
1997-2006
State
250
EUR, miljoenen
200
150
100
52
53
52
Patients
50
46
170
178
174
45
44
169
153
39
42
38
146
139
123
122
108
50
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Outline of Presentation

Antibiotic resistance in Europe (EARSS)

Antibiotic consumption in Europe (ESAC)

Link between use and resistance
•
At population level
•
At individual level

Strategies to curb resistance in Belgium

EU Antibiotic Day

Conclusions
Why do we need another awareness day?

Awareness days have shown to mobilise people, politicians, resources,
... (Drinking and Driving; AIDS Day)

Consolidate “healthy” situation of low antibiotic use and resistance (e.g.
North) or reverse situation of emerging resistance (e.g. South)

Success of national campaigns in Belgium and France: reduction of
antibiotic use and resistance in primary care and hospitals

Empty pipeline of new antibiotics; new rapid diagnostic tests not yet
available

The EC supports many public health and research programmes which
allow to measure the impact of campaigns and provide materials:
•
ECDC: EARSS (antibiotic resistance), ESAC (antibiotic use), …
•
DG SANCO: e-BUG (educational packs for children), …
•
DG RESEARCH: GRACE (qualitative research), CHAMP
(database on campaigns, questionnaires, economic impact), …
EUROPE IS READY TO KICK OFF AN EU ANTIBIOTIC DAY
How did we get here?

September 07: AMR focal group unanimously
agreed on need for EU Antibiotic Day

October 07: Member States and MEPs support
the idea of an EU Antibiotic Day

October 07: ECDC’s Director launches first EU
Antibiotic Day for…18 November 2008

January 08: Installation of Technical Advisory
Group at ECDC

March 08: Selection of logo, slogans, etc
What will be done?


By ECDC:
•
Development of slogan, logo & key messages
•
Launch of public website
•
Delivery of media toolkit
•
Press conference in European Parliament on 18 November
By Member States:
•
Press conference with Health experts & AMR experts
•
National conference on AMR involving doctors, pharmacists, vets &
dentists
•
Editorials in national medical journals
•
Letter from Health Minister to all doctors
•
Leaflets & posters for general public
•
Development of in-school activities for children & parents
•
TV spots
Suggested logo/slogan
Outline of Presentation

Antibiotic resistance in Europe (EARSS)

Antibiotic consumption in Europe (ESAC)

Link between use and resistance
•
At population level
•
At individual level

Strategies to curb resistance in Belgium

EU Antibiotic Day

Conclusions
Conclusions: what can be done?
First EU Antibiotic Day on November 18, 2008
•
Reduce unnecessary antibiotic use (e.g. in patients with common
colds and flu)
•
Raise awareness that overuse of antibiotics will increase antibiotic
resistance, through increasing awareness of the public (e.g. public
campaigns), professsionals (e.g. undergraduate and postgradute
education), and children (e.g. educational packs in schools).
•
Ensure that public campaigns employ techniques of social
marketing and use appropriate quality indicators and outcome
measures, such as antibiotic use and resistance
•
Monitor adverse effects associated with a reduction in antibiotic
prescribing
•
Support the use of rapid point-of-care diagnostic tests which result
in reduced antibiotic prescribing
•
Provide incentives for benchmarking of antibiotic prescribing in
hospitals and nursing homes through quality indicators, such as
Longitudinal and Point Prevalence Surveys
The European Union is making the Difference!
“The European Dream emphasizes community
relationships over individual autonomy, cultural
diversity over assimilation, quality of life over the
accumulation of wealth, sustainable development
over unilateral material growth, deep play over
unrelenting toil, universal human rights and the
rights of nature over property rights, over global
cooperation over the unilateral exercise of
power”
From: The European Dream, by Jeremy Rifkin