European Antibiotics Awarness Day
Download
Report
Transcript European Antibiotics Awarness Day
Using antibiotics prudently
- Hospital Prescriber Presentation
[Insert Name of presenter]
[Insert Name of hospital]
Contents of this presentation
• Antibiotic resistance – a patient safety issue
– Situation in Ireland
– Drivers of antibiotic resistance
– Consequences of antibiotic resistance
• Why inappropriate use of antibiotics contributes to
antibiotic resistance – the “why”
• How prudent use of antibiotics can be promoted in
hospitals – the “how”
• European Antibiotic Awareness Day – a campaign to
promote prudent use of antibiotics
2
Antibiotic resistance
– a patient safety issue
3
Antibiotic resistance –
a problem in the present and the future
• Antibiotic resistance is an increasingly serious public health problem:
resistant bacteria have become an everyday concern in Irish hospitals.
Proportion of resistant isolates (%)
40
30
20
10
0
2002
2003
2004
2005
2006
2007
2008
2009
Penicillin-non susceptible S. pneumoniae
Erythromycin-resistant S. pneumoniae
Fluoroquinolone-resistant E. coli
Third-gen. cephalosporin-resistant E. coli
Vancomycin-resistant E. faecium (VRE)
4
Trends in antibiotic resistance (invasive infections) in Ireland, 2002-2009. Source: European Antimicrobial
Resistance Surveillance System (EARSS) and Health Protection Surveillance Centre (HPSC).
Meticillin-resistant Staphylococcus aureus
(MRSA) bloodstream infections in Europe
2002
2007
No data
<1%
1-5%
5-10%
10-25%
25-50%
>50%
Source: European Antimicrobial Resistance Surveillance System (EARSS), 2008.
5
S. aureus/MRSA bacteraemia trends by quarter,
2002-2010Q2*
450
23
28
41
42
42
55%
44
43
43
50%
350
45%
300
250
40%
200
35%
150
30%
100
25%
50
20%
Q1 2002
Q2 2002
Q3 2002
Q4 2002
Q1 2003
Q2 2003
Q3 2003
Q4 2003
Q1 2004
Q2 2004
Q3 2004
Q4 2004
Q1 2005
Q2 2005
Q3 2005
Q4 2005
Q1 2006
Q2 2006
Q3 2006
Q4 2006
Q1 2007
Q2 2007
Q3 2007
Q4 2007
Q1 2008
Q2 2008
Q3 2008
Q4 2008
Q1 2009
Q2 2009
Q3 2009
Q4 2009
Q1 2010
Q2 2010
0
Total S.aureus
Quarter
MRSA
%MRSA
* Data for 2010 provisional up to the end of Q2;
Number of laboratories participating by year-end indicated above the Q4 bars
%MRSA
Number of isolates
400
MRSA in Europe, 2007: often high, but decreasing in
many countries
No. of countries
Ireland
MRSA (%)
Country with a significant increase (2005–2007)
Country with a significant decrease (2005–2007)
Source: EARSS & ECDC, 2009
7
Antimicrobial resistance in gram-negative bacteria, EU,
2007: already high or increasing
No. of countries
Country with a significant increase (2005-2007)
Country with a significant decrease (2005-2007)
Source: EARSS & ECDC, 2009
No. of countries
Carbapenem-resistant Pseudomonas aeruginosa (%)
3rd-gen. ceph.-resistant Escherichia coli (%)
8
3rd-gen. ceph.-resistant Klebsiella pneumoniae (%)
Total outpatient antibiotic use in EU Member
States, Iceland and Norway, 2008
* Total use, i.e. including inpatients (CY, GR, LT).
** Reimbursement data, i.e. not including over-the-counter sales without a prescription (ES)
*** Data from 2007 (MT)
9
Source: European Surveillance of Antimicrobial Consumption (ESAC), 2010. In: ECDC Annual
Epidemiological Report 2010: in press.
Antibiotic consumption in acute hospitals
in Ireland: 2007 to Q2 2010
80
70
60
50
40
30
20
10
General
Regional/Tertiary
2010Q2
2010Q1
2009Q4
2009Q3
2009Q2
2009Q1
2008Q4
2008Q3
2008Q2
2008Q1
2007Q4
2007Q3
2007Q2
0
2007Q1
Antibiotic Usage Rate (DDD/100BDU)
90
Specialist
Data source: HPSC
Fluoroquinolone consumption in acute
hospitals in Ireland: 2007 to Q2 2010
Antibiotic Usage Rate (DDD/100BDU)
12
10
8
6
4
2
General
11
Regional/Tertiary
2010Q2
2010Q1
2009Q4
2009Q3
2009Q2
2009Q1
2008Q4
2008Q3
2008Q2
2008Q1
2007Q4
2007Q3
2007Q2
2007Q1
0
Specialist
Data source: HPSC
Hospital antibiotic prevalence survey,
2009: prevalence of antibiotic use
Hospital antibiotic prevalence survey,
2009: indications for antibiotic use
Healthcareassociated
infection
33%
Community
acquired
infection
51%
Medical
prophylaxis
6%
13
Surgical
prophylaxis
10%
Hospital antibiotic prevalence survey, 2009:
duration of peri-operative prophylaxis
>1 day
66%
Single dose
11%
One day
23%
14
Antibiotic use at (insert hospital name)
Insert individual hospital antibiotic consumption data, available from
hospital pharmacist or from Ajay Oza at HPSC
Antibiotic resistance –
A patient safety issue for all hospitals
• The emergence, selection and spread of resistant bacteria
in hospitals is a major patient safety issue.
– Infections with antibiotic-resistant bacteria can result in increased
patient morbidity and mortality, as well as increased hospital length
of stay.1-2
– Antibiotic resistance frequently leads to a delay in appropriate
antibiotic therapy.3
– Inappropriate or delayed antibiotic therapy in patients with severe
infections is associated with worse patient outcomes and sometimes
death.4-6
16
1. Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003 Jun 1;36(11):1433-7.
2. Roberts RR, Hota B, Ahmad I, Scott RD, 2nd, Foster SD, Abbasi F, et al. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect
Dis. 2009 Oct 15;49(8):1175-84.
3. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999 Feb;115(2):462-74.
4. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000 Jul;118(1):146-55.
5. Lodise TP, McKinnon PS, Swiderski L, Rybak MJ. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis. 2003 Jun 1;36(11):1418-23.
6. Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired neumonia Study Group. Intensive Care Med. 1996 May;22(5):387-94.
Antibiotic resistance –
a daily occurrence in our hospital
• In our [country / hospital] the most frequent resistant
infections are the following [insert appropriate data where
available].
• These infections have resulted in [insert data on additional
days of hospitalisation, morbidity, mortality, and costs
where available].
17
Why inappropriate use of antibiotics contributes to
antibiotic resistance
– the “why”
18
In-patients are at high risk of antibiotic-resistant
infections
• Misuse of antibiotics in hospitals is one of the main factors
that drive development of antibiotic resistance.7-9
• Patients in hospitals have a high probability of receiving an
antibiotic10 and 50% of all antibiotic use in hospitals can be
inappropriate.11-12
• In a 2009 prevalence survey of antibiotic use in Irish
hospitals:
– 34% of patients were receiving antibiotics on the day of the
survey
– 42% of antibiotic use did not follow evidence-based guidelines
7. Singh N, Yu VL. Rational empiric antibiotic prescription in the ICU. Chest. 2000 May;117(5):1496-9.
8. Lesch CA, Itokazu GS, Danziger LH, Weinstein RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis. 2001 Nov;41(3):149-54.
9. Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2002 Sep;46(9):2920-5.
10. Ansari F, Erntell M, Goossens H, Davey P. The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis. 2009 Nov
15;49(10):1496-504.
11. Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2005(4):CD003543.
Willemsen I, Groenhuijzen A, Bogaers D, Stuurman A, van Keulen P, Kluytmans J. Appropriateness of antimicrobial therapy measured by repeated prevalence surveys. Antimicrob Agents Chemother. 2007
19 12.
Mar;51(3):864-7.
Misuse of antibiotics drives antibiotic resistance
• Studies prove that misuse of antibiotics may cause patients
to become colonised or infected with antibiotic-resistant
bacteria, such as;
– Meticillin-resistant Staphylococcus aureus (MRSA)
– Vancomycin-resistant enterococci (VRE)
– Highly-resistant Gram-negative bacilli
13-14
E.g. E. coli, Klebsiella sp., Pseudomonas sp.
• Misuse of antibiotics is also associated with an increased
incidence of Clostridium difficile infections.15-17
20
13. Safdar N, Maki DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and
Candida. Ann Intern Med. 2002 Jun 4;136(11):834-44.
14. Tacconelli E, De Angelis G, Cataldo MA, Mantengoli E, Spanu T, Pan A, et al. Antibiotic usage and risk of colonization and infection with antibiotic-resistant bacteria: a hospital population-based study. Antimicrob
Agents Chemother. 2009 Oct;53(10):4264-9.
15. Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 15. 2005(4):CD003543.
16. Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003 Sep;24(9):699-706.
17. Fowler S, Webber A, Cooper BS, Phimister A, Price K, Carter Y, et al. Successful use of feedback to improve antibiotic prescribing and reduce Clostridium difficile infection: a controlled interrupted time series. J
Antimicrob Chemother. 2007 May;59(5):990-5.
What is misuse of antibiotics?
Misuse of antibiotics can include any of the following18:
• When antibiotics are prescribed unnecessarily;
• When antibiotic administration is delayed in critically ill
patients;
• When broad-spectrum antibiotics are used too generously, or
when narrow-spectrum antibiotics are used incorrectly;
• When the dose of antibiotics is lower or higher than
appropriate for the specific patient;
• When the duration of antibiotic treatment is too short or too
long;
• When antibiotic treatment is not streamlined according to
microbiological culture data results.
21
18. Gyssens IC, van den Broek PJ, Kullberg BJ, Hekster Y, van der Meer JW. Optimizing antimicrobial therapy. A method for antimicrobial drug use evaluation. J Antimicrob Chemother. 1992 Nov;30(5):724-7.
Benefits of prudent use of antibiotics
• Prudent use of antibiotics can prevent the emergence and selection of
antibiotic-resistant bacteria.19-23
• Decreasing antibiotic use have also been shown to result in lower
incidence of Clostridium difficile infections.24-26
Rates of Vancomycin-resistant Enterococci in hospital before and after
implementation of the antibiotic management program compared with
rates in National Nosocomial Infections Surveillance (NNIS) System*
hospitals of similar size.27
*NNIS is now the National Healthcare Safety Network (NHSN).
22
Rates of nosocomial Clostridium difficile, expressed per 1,000 patientdays, before and after implementation of the antibiotic management
program.28
19, 24. Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2005(4):CD003543.
20. Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2002 Sep;46(9):2920-5.
21, 25, 27, 28. Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003 Sep;24(9):699-706.
22. Bradley SJ, Wilson AL, Allen MC, Sher HA, Goldstone AH, Scott GM. The control of hyperendemic glycopeptide-resistant Enterococcus spp. on a haematology unit by changing antibiotic usage. J Antimicrob
Chemother.
23. De Man P, Verhoeven BAN, Verbrugh HA, Vos MC, Van Den Anker JN. An antibiotic policy to prevent emergence of resistant bacilli. Lancet. 2000;355(9208):973-8.
26. Byl B, Clevenbergh P, Jacobs F, Struelens MJ, Zech F, Kentos A, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis.
1999 Jul;29(1):60-6; discussion 7-8.
How prudent use of antibiotics can be promoted in
hospitals
– the “how”
23
Multifaceted strategies can address and
decrease antibiotic resistance in hospitals
• Antibiotic prescribing practices
and decreasing antibiotic
resistance can be addressed
through multifaceted strategies
including:29-31
– Use of ongoing education
– Use of evidence-based hospital
antibiotic guidelines and policies
– Restrictive measures and
consultations from
microbiologists, infectious disease
physicians and pharmacists
29. Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2005(4):CD003543.
30. Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003 Sep;24(9):699-706.
31. Byl B, Clevenbergh P, Jacobs F, Struelens MJ, Zech F, Kentos A, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin
Infect Dis. 1999 Jul;29(1):60-6; discussion 7-8.
24
Measures that can decrease antibiotic resistance
Measures that guide antibiotic prescribing are likely to decrease antibiotic
resistance in hospitals.32-34 Such measures include:
Obtaining cultures
Take appropriate and early cultures before initiating empiric antibiotic therapy,
and streamline antibiotic treatment based on the culture results35
Monitoring local antibiotic resistance patterns
Being aware of local antibiotic resistance patterns (antibiograms) enables
appropriate selection of initial empiric antibiotic therapy36
Consulting specialists
Involve infectious disease physicians, microbiologists and pharmacists in your
decisions about antibiotic therapy during your patient’s stay37-39
25
32, 37. Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2005(4):CD003543
33, 38. Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003 Sep;24(9):699-706.
34, 39. Byl B, Clevenbergh P, Jacobs F, Struelens MJ, Zech F, Kentos A, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect
Dis. 1999 Jul;29(1):60-6; discussion 7-8.
35. Rello J, Gallego M, Mariscal D, Sonora R, Valles J. The value of routine microbial investigation in ventilator-associated pneumonia. Am J Respir Crit Care Med. 1997 Jul;156(1):196-200.
36. Beardsley JR, Williamson JC, Johnson JW, Ohl CA, Karchmer TB, Bowton DL. Using local microbiologic data to develop institution-specific guidelines for the treatment of hospital-acquired pneumonia. Chest. 2006
Sep;130(3):787-93.
Our hospital tools
for prudent antibiotic prescribing
• [Hospital antibiogram if available]
• [Hospital guidelines if available]
• [Antibiotic stewardship committee if it exists]
• [Names of infectious diseases / antibiotic experts]
26
Antibiotics – handle with care
• Misuse of antibiotics leads to resistance40-42
• All hospital practitioners can play an active role in
reversing the trend of antibiotic-resistant bacteria:
– Take cultures before starting antibiotic therapy43
– Consult the hospital antibiotic expert44-46, [local antibiogram, and
hospital antibiotic guidelines]
– Streamline antibiotic therapy based on culture results47
27
40. Singh N, Yu VL. Rational empiric antibiotic prescription in the ICU. Chest. 2000 May;117(5):1496-9.
41. Lesch CA, Itokazu GS, Danziger LH, Weinstein RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis. 2001 Nov;41(3):149-54.
42. Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2002 Sep;46(9):2920-5.
43, 47. Rello J, Gallego M, Mariscal D, Sonora R, Valles J. The value of routine microbial investigation in ventilator-associated pneumonia. Am J Respir Crit Care Med. 1997 Jul;156(1):196-200.
44. Davey P, Brown E, Fenelon L, Finch R, Gould I, Hartman G, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2005(4):CD003543
45. Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003 Sep;24(9):699-706.
47.Byl B, Clevenbergh P, Jacobs F, Struelens MJ, Zech F, Kentos A, et al. Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia. Clin Infect Dis.
1999 Jul;29(1):60-6; discussion 7-8.
European Antibiotic Awareness Day
– a campaign to promote prudent use of
antibiotics
28
About
European Antibiotic Awareness Day
• European Antibiotic Awareness Day is marked across
Europe around 18 November.
• European Antibiotic Awareness Day provides a platform
and support to national campaigns about prudent antibiotic
use in the community and in hospitals.
29
European Antibiotics Awareness Day:
Planned local activities
• [Insert planned local activities, highlighting where
involvement by the audience of this presentation would be
welcome]
30
THANK YOU!
• For more information on data sources and references,
please visit:
– http://antibiotic.ecdc.europa.eu
– www.hpsc.ie
31
32