Transcript The Global Challenge and the Swedish Experience

The Swedish Experience
Otto Cars
Prof. Infectious Diseases
Uppsala University Hospital
Sweden
The Global Challenge
Antibiotics are losing their effect at a pace
that was unforeseen just five years ago
The pipeline of new drugs is empty
ESBL (CTX-M) producing Enterobacteriaceae
2001-2002
Endemicity
Sporadic reports
2007
Endemicity
Sporadic reports
2005
The consequences…….
Bloodstream infection: 43.5% of the children with Gramnegative bloodstream infection died in a Tanzanian study
(Blomberg, 2007).
ESBL & MDR Gram-negatives: In Israel 3% of all
fatalities in hospitals related to Gram-negative
multiresistant nosocomial infections (Carmeli, 2006).
www.reactgroup.org
Clonal outbreak of av multiresistant
Klebsiella pneumoniae Uppsala
University Hospital
The Current Paradox:
Antibiotic
Resistance
Drug
Development
Morbidity
Mortality
Costs
Hip replacement
Transplants
Cancer chemotherapy
Infections in preterm
babies
The Swedish Experience
The Swedish Strategic Programme
Against Antibiotic Resistance
Overall objective
To preserve effective
antibacterial therapy
for the future
http:// www.strama.se
NATIONAL LEVEL
National co-ordinating group
Surveillance
National projects
LOCAL LEVEL
Local co-ordinating groups
Implementation
Behavioural change
Projects and interventions initiated in many areas
Primary
care
Intensive
care
Hospital
care
Nursing
homes
Day care
centres
School
children
NATIONAL LEVEL
National co-ordinating group
Surveillance
National projects
LOCAL LEVEL
Local co-ordinating groups
Implementation
Behavioural change
• Strama-groups were formed in every county.
• The County Medical Officers for Communicable
have a leading role in these groups which include
specialists from different medical fields
• The main objective is to evaluate the use
antibiotics and antibacterial resistance in the
region and to improve prescribing patterns
Strama-some examples of activities
•Local implementation of guidelines
•Sales statistics, Resistance data
•Feedback and audit
•Newsletter, website,
•Fund for local projects
•Educational activities “ Strama workshops”
Effect of prescriber feedback on consumption of fluoroquinolones
in four primary care districts of Uppsala County
DDD/1000ính/day
1,8
1,6
1,4
1,2
1995
1
1996 0,8
0,6
0,4
0,2
0
n
1
2
3
4
e
t
t
t
t
d
ic
ic
ic
ic
e
r
r
r
r
t
t
t
t
s
s
s
s
Sw
Di
Di
Di
Di
Effect of prescriber feedback on consumption of fluoroquinolones
in four primary care districts of Uppsala County
DDD/1000ính/day
1,8
1,6
1,4
1995 1,2
1
1996
1997 0,8
0,6
0,4
0,2
0
1
2
3
4
en
t
t
t
t
d
ic
ic
ic
ic
e
r
r
r
r
t
t
t
t
w
s
s
s
s
S
i
i
i
i
D
D
D
D
Awareness raising of all
stakeholders through news media
Patient
Authorities
Prescriber
MEDIA
Prescriptions
of antibiotics
foröppenvård
UTI (outpatients)
till kvinnor,
UVI-medel
60
2000
2001
2002
50
2003
2004
2005
Recipen/1000/år
40
2006
2007
30
20
10
0
J01CA08 - pivmecillinam
J01EA01 - trimetoprim
J01XE01 - nitrofurantoin
Kinoloner (norfloxacin + små
cipro)
Fluoroquinolones
”Små cipro” avser ciprofloxacin 100 mg 6 resp 10 tabl, 250 mg 10 tabl och 500 mg 10 tabl.
Total sales of Antibiotics in the Nordic Countries 1978-2006*
25
15
10
Iceland
Finland
Sweden
Norway
5
Denmark
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
DDD/1000 inhabitants/day
20
*Excluding Metenamine. Before 1998 figures from Denmark do not include hospital use
.
Possible success factors
Multidisciplinary coordinating groupinvolving all stakeholders
Governmental support and mandate
Decentralised organisation and local ownership
Credible, scientifically based messages and actions
Clear communication and media strategy
Conclusions
It is possible to achieve a significant change in
antibiotic use at the national level.
To be sustainable, political/financial support is needed.
Despite low antibiotic consumption resistance rates
are incrasing
ReAct
Action on
Antibiotic Resistance
www.reactgroup.org