Transcript Recommendation on prudent use of antimicrobial agents in

Recommendation on prudent use of
antimicrobial agents in human
medicine – Slovenian experiences
Intersectoral Coordination Mechanism
Prof. Milan Čižman, MD, Head
Implementation of the Council
recommendation 2002/77/EC on the prudent
use of antimicrobial agents in human
medicine in Slovenia
• Intersectoral coordination mechanism
established in 2005
• National strategy prepared in 2006
• National action plan formulated in 2006
Agenda
• MRSA prevalence in Slovenia 2000-2006
– 21.4% to 7.1% - reduction of 67%
• Outpatient antibiotic use in Slovenia 2000 –
2007
– 20.1 to 16.0 DDD/1000 inhab./day – reduction 20.3%
• Increase of VRE prevalence  2005-2006
– <1 to 6%
• Recommendations
– MRSA
– antibiotic consumption in outpatients
www.rivm.ne/earss
10
7,1
10
13
16
10,3
11,8
11,5
7,30
15
12,7
%
14,70
20
13,8
16,70
20,50
21,4
30
25
Slovenia
UMC
19,6
35
28,30
33,30
Resistance levels (%) for invasive strains of S.
aureus to methicillin (MRSA) in Slovenia and at
University Medical centre (UMC), Ljubljana, Slovenia
5
0
1998
1999
2000*
2001*
2002*
2003*
Year
2004*
2005*
2006*
2007*
MRSA in Slovenia /1
• PPS of hospital acquired infections (HAI)
in Slovenian adult ICU, April 1997 – 6/8
(75% of adult ICUs)
• PPS of HAI in Slovenian adults ICU,
October 2001 – 5/8 (60 % of adult ICUs)
• National PPS of HAI in acute care
hospitals, October 2001 - 21/34 (62% of
acute care hospitals)
Muzlovic I, et al. IDSA 2001.
Klaus I, et al. J Hosp Infect 2003, 54: 149.
MRSA in Slovenia /2
• Comprehensive infection control program: MRSA
cases acquired in hospitals decreased from 50%
to 6.1% (1999-2002)
• Infection control measures: incidence of ICU –
acquired MRSA decreased from 7.8 to 1.9 %.
• Legislation and regulation of infection control
program in health care institutions (1999)*
• Audit of infection control implementations in
health cares institutions (2006)**
Tomič V, et al. Arch Intern Med 2004, 164:2038
Trampuž A. ICAAC 2001 K-1219
*Official Journal of the R Slovenia. Uradni list RS. št. 743597/1999
**Official Journal of the R Slovenia. Uradni list RS. št. 92/2006
Strategy for MRSA in Slovenia /1
• Active Surveillance Culture
– Selective screening for MRSA in all patients at
risk for carriage on admission.
• Barrier precautions for patients
– Contact isolation for patient with MRSA
• Promotion of hand hygiene
– Use of alcohol–based hand rub
• Selective decolonization – eradication of
MRSA carriage
Strategy for MRSA in Slovenia /2
• Improved communication (reporting)
about patients with MRSA (MDROs)
within and between health care
facilities.
• Continuous education of HCW on
appropriate hygiene procedures
(hospitals, nursing homes).
• Use of hospital computer system to
record MRSA carriers.
Strategy for MRSA in Slovenia /3
Education
• Professionals
– Postgraduate educational courses are
organized by Medical Faculty Ljubljana since
1984 (162 physicians and 290 nurses).
– National scientific meetings
• Patients
– Newspapers, magazines, TV, leaflets
• Spread of informations to media and
politicians.
Outpatient antibiotic use in Slovenia
1997-2007
2
Outpatient consumption of amoxicillin/clavulanate
before and after restriction
AMC
DDD/1000 inhabitants
restriction
pre-trend
post-trend
1,5
1
0,5
0
1996
1998
2000
2002
2004
quartiles
2006
2008
2010
Outpatient consumption of fluoroquinolones
before and after restriction
0,5
FQ
pre-trend
DDD/1000 inhabitants
restriction
0,4
post-trend
0,3
0,2
0,1
0
1996
1998
2000
2002
2004
quartiles
2006
2008
2010
Analysis of decreased outpatient
antibiotic consumption in Slovenia
• The consumption decreased more for
restricted than for non-restricted antibiotics:
27.7% vs 16.1% decrease (1999-2007)
• Positive correlation between antibiotic
consumption and repeated media reports
• Negative correlation between antibiotic
consumption and the number of rapid
diagnostic tests (CRP, Streptococcal antigen
tests)
Antibiotic prescriptions (J01) in children (0-14 years)
and adults ( 15 years) and %penicillin-nonsusceptible (I+R) S. pneumoniae, 2002-2006
45
1400
40
1200
Resistance (I+R) %
1000
30
25
800
20
600
15
400
10
200
5
0
0
2002
2003
2004
2005
2006
Resistence of S. pneumoniae - children
Resistence of S. pneumoniae - adults
No of prescriptions for J01 for children
No of prescriptions for J01 for adults
No.of prescriptions J01
35
CONCLUSION
• Compliance to infection control guidelines for
MRSA control
• Nation-wide awareness: HCW, lay public,
politicians
• Enough single rooms, and staff
• To control antibiotic consumption in outpatients
the combinations of restrictive and education
measures are recommended
• Prudent use of rapid diagnostic tests may
decrease the antimicrobial consumption in
outpatients
• Higher antibiotic consumption and resistance
rates in certain bacteria are observed in children