Transcript Figure 3.1. Antibiotics, out-patient care in Sweden (J01), DDD/1000/day, 2000-2003. Methenamine (J01XX05) Antibiotics (J01) excl methenamine DDD/1000/inh/day.

Figure 3.1. Antibiotics, out-patient care in Sweden (J01), DDD/1000/day, 2000-2003.
18
Methenamine (J01XX05)
Antibiotics (J01) excl methenamine
16
DDD/1000/inh/day
14
12
10
8
6
4
2
0
2000
2001
2002
2003
Figure 3.2. Out-patient care, changes in consumption 2003 compared to 2000, DDD/1000/day
Beta-lactamase resistant penicillins (J01CF)
Lincosamides (J01FF)
Nitrofurantoin (J01XE)
Pivmecillinam (J01CA08)
Penicillins with extended spectrum excl pivmec (J01CA)
Trimethoprim and sulfonamides (J01EE)
Combinations of penicillins (J01CR)
Trimethoprim (J01EA)
Quinolones (J01MA)
Cephalosporins (J01DA)
Macrolides (J01FA)
Tetracyclines (J01AA)
Beta-lactamase sensitive penicillins (J01CE)
-0,6
-0,5
-0,4
-0,3
-0,2
DDD/1000/day
-0,1
0
0,1
0,2
Figure 3.2. Out-patient care, percent change in consumption 2003 compared to 2000
Lincosamides (J01FF)
Nitrofurantoin (J01XE)
Beta-lactamase resistant penicillins (J01CF)
Pivmecillinam (J01CA08)
Penicillins with extended spectrum exkl pivmec (J01CA)
Trimethoprim and sulfonamides (J01EE)
Quinolones (J01MA)
Trimethoprim (J01EA)
Combinations of penicillins (J01CR)
Tetracyclines (J01AA)
Beta-lactamase sensitive penicillins (J01CE)
Cephalosporins (J01DA)
Macrolides (J01FA)
-30%
-20%
-10%
0%
10%
DDD/1000/day
20%
30%
40%
Figure 3.4. Swedish counties, beta-lactamase resistant penicillins (J01CF), DDD/1000/day,
2000-2003. The counties are sorted after the highest use 2003. Data is standardized to
minimize differences in age and sex in the population.
2
1,8
1,4
1,2
1
0,8
2000
2001
2002
2003
0,6
0,4
RIKET
Västerbotten
Östergötland
Blekinge
Värmland
Jönköping
Dalarna
Skåne
Kronoberg
Västmanland
Gävleborg
Västra Götaland
Södermanland
Jämtland
Västernorrland
Stockholm
Halland
Norrbotten
Kalmar
Uppsala
0
Örebro
0,2
Gotland
DDD/1000/day
1,6
0
RIKET
Östergötland
Västerbotten
Västernorrland
Jönköping
Kronoberg
Kalmar
Dalarna
Blekinge
Värmland
Gävleborg
Södermanland
Skåne
Halland
Stockholm
Västra Götaland
Norrbotten
Västmanland
4
Jämtland
6
Uppsala
Gotland
Örebro
DDD/prescription
Figure 3.5. Swedish counties, beta-lactamase resistant penicillins (J01CF), DDD/prescription,
2000-2003. The counties are sorted after the highest use 2003.
14
12
10
8
2000
2001
2002
2003
2
jan
m 00
ar
m 00
aj 00
jul
se 00
p0
no 0
v0
jan 0
m 01
ar
m 01
aj 01
jul
se 01
p0
no 1
v0
jan 1
m 02
ar
-0
m 2
aj 02
jul
-0
se 2
p0
no 2
v0
jan 2
m 03
ar
-0
m 3
aj 03
jul
-0
se 3
p0
no 3
v0
jan 3
-0
4
DDD/1000/day
Figure 3.6. Beta-lactamases resistant penicillins (J01CF),
out-patient care, per month 2000-2003, different age groups.
6
0-4
5 - 9,
10 - 14,
15 - 19
20 - 59
60 - 79
80 -
5
4
3
2
1
0
Figure 3.7. Proportion of pivmecillinam, nitrofurantoin and trimethoprim, DDD, men in out-patient care,
2000-20003 Sweden
100%
J01XE01 nitrofurantoin
Proportion in DDD
80%
J01EA01 trimetoprim
60%
J01CA08 pivmecillinam
40%
20%
0%
2000
2001
2002
2003
Figure 3.8. Proportion of pivmecillinam, nitrofurantoin and trimethoprim, DDD, women in out-patient care,
2000-2003 Sweden
100%
J01XE01 nitrofurantoin
Proportion in DDD
80%
J01EA01 trimetoprim
60%
J01CA08 pivmecillinam
40%
20%
0%
2000
2001
2002
2003
Figure 3.9. Antibiotics (J01) hospital care, changes, DDD/1000/day, 2003 compared to 2000.
Penicillins with extended spectrum (J01CA)
Beta-lactamase resistant penicillins (J01CF)
Quinolones (J01MA)
Trimethoprim (J01EA)
Combinations of penicillins (J01CR)
Lincosamides (J01FF)
Carbapenems (J01DH)
Trimethoprim and sulfonamides (J01EE)
Glycopeptides (J01XA)
Cefalosporins (J01DA)
Imidazole derivatives (J01XD)
Aminoglycosides (J01GB)
Tetracyclines (J01AA)
Macrolides (J01FA)
Beta-lactamase sensitive penicillins (J01CE)
-0,015
-0,01
-0,005
0
0,005
DDD/1000/day
0,01
0,015
0,02
0,025
Figure 3.10. Antibiotics (J01) hospital care, percent changes, DDD/1000/day, 2003 compared to 2000.
Combinations of penicillins (J01CR)
Trimethoprim (J01EA)
Glycopeptides (J01XA)
Penicillins with extended spectrum (J01CA)
Lincosamides (J01FF)
Carbapenems (J01DH)
Beta-lactamase resistant penicillins (J01CF)
Quinolones (J01MA)
Trimethoprim and sulfonamides (J01EE)
Cefalosporins (J01DA)
Imidazole derivatives (J01XD)
Tetracyclines (J01AA)
Beta-lactamase sensitive penicillins (J01CE)
Aminoglycosides (J01GB)
Macrolides (J01FA)
-20%
-10%
0%
10%
20%
% DDD/1000/day
30%
40%
50%
Figure 3.100. Vancomycin, teicoplanin and linezolid, DDD/1000/day in hospital care,
2000-2003.
linezolid
(J01XX08)
0,014
DDD/1000/day
0,012
teikoplanin
(J01XA02)
0,01
0,008
vancomycin
(J01XA01)
0,006
0,004
0,002
0
2000
2001
2002
2003
DDD per 1000 inh. per day
Figure 3.12. Total out-patient antibiotic use in 26 European countries 2001.
Others
J01B+J01G+J01X
J01DF+J01DH
35
Sulfonamides and
trimethoprim
J01E
30
Quinolones
J01M
25
20
Macrolides, Lincosam.,
Streptogramins
J01F
15
Tetracyclines
J01A
Cephalosporins
J01DA
10
5
Penicillins
J01C
0
FR GR LU IT PL PT BE SK BG IS IE FI HU ES CZ HR SI SE NO EE UK LV DE DK AT NL
ja
n0
m 0
ar
-0
m 0
aj
-0
0
ju
lse 00
p0
no 0
v0
ja 0
n0
m 1
ar
-0
m 1
aj
-0
1
ju
lse 01
p0
no 1
v0
ja 1
nm 02
ar
-0
m 2
aj
-0
2
ju
l-0
se 2
p0
no 2
v0
ja 2
nm 03
ar
-0
m 3
aj
-0
3
ju
l-0
se 3
p0
no 3
v0
ja 3
n04
DDD/1000/day
Figure 3.13. Antifungals for systemic use (D01B - fungal skin infections) out-patient care.
1
0,9
0,8
0,7
0,6
0,5
0,4
0,3
0,2
0,1
0
Figure 3.14. Antifungals for systemic use (J02), hospital care,
2000-2003, DDD/1000/day.
0,07
DDD/1000/day
0,06
Caspofungin
Voriconazole
Itraconazole
Fluconazole
Ketoconazole
Amphotericin B
0,05
0,04
0,03
0,02
0,01
0
2000
2001
2002
2003
Figure 4.2. Overall national resistance rates (resistant isolates in
percent of all pneumococcal isolates) for four different antibiotics
1994-2003 (data from the annual RSQC programme, approximately
3000 isolates per year).
1994
10
1995
1996
%R
8
1997
1998
6
1999
4
2000
2001
2
2002
2003
0
Penicillin I+R (oxa
screen)
Erythromycin
Tetracycline
Trimethoprimsulfonamide
Figure 4.3. Frequencies of reduced susceptibility to penicillin among invasive isolates of
Streptococcus pneumoniae in Europe 2003. Data from EARSS (www.ears.rivm.nl).
Estonia (26)
% intermediate
% resistant
Netherlands (343)
Czech rep. (204)
Denmark (606)
England (668)
Sw eden (916)
Austria (146)
Finland (490)
Slovakia (27)
Belgium (1488)
Ireland (362)
Italy (201)
Bulgaria (22)
Slovenia (172)
Luxembourg (48)
Poland (16)
Croatia (87)
Portugal (95)
Hungary (134)
Spain (654)
Romania (22)
Israel (180)
0
5
10
15
20
25
Proportion of isolates (%)
30
35
40
45
Figure 4.4. Age adjusted incidence of MRSA (n=549 cases).
Incidence (number of cases/100 000 inh.)
30
25
20
15
10
5
0
00-09
10-19
20-29
30-39
40-49
50-59
Age
60-69
70-79
80-89
90-
Figure 4.5. MRSA, reported mode of domestic health care related acquisition.
Hospital
Outside hospital
Occupational
15%
23%
62%
Figure 4.6. MRSA in Europe 2003, invasive isolates.
Data from EARSS (www.earss.rivm.nl).
Denmark (671)
Netherlands
Sweden (1854)
Finland (727)
Estonia (98)
Czech rep.
Slovakia (267)
Slovenia (299)
Austria (747)
Hungary (858)
Germany (225)
Poland (166)
Luxembourg (95)
Spain (1391)
Belgium (1141)
Bulgaria (157)
Croatia (360)
Italien (394)
Ireland (1109)
Malta (122)
Israel (368)
England (1877)
Portugal (1033)
Romania (85)
Greece (321)
0,00
10,00
20,00
30,00
% MRSA
40,00
50,00
60,00
Figure 4.7. Reported VRE cases by county 2000-2003
(counties not in the graph did not report any case).
14
2000
2001
2002
2003
12
Number
10
8
6
4
2
0
Blek Hall Jkpg Jmtl Kalm Kron Skån Sthm Södm Upps Vbtn Vgöt Vrml Vstm Öreb Östg
County
Figure 4.8. Reported VRE cases 2000-2003; age adjusted incidence.
Cases / 100 000 pop.
4,5
4
3,5
3
2,5
2
1,5
1
0,5
0
0-19
20-29
30-39
40-49
50-59
Age interval
60-69
70-79
80+
Figure 4.9. Resistance rates (resistant isolates in percent of all
Streptococcus pyogenes isolates) for three different antibiotics
1994-2003.
20
1994
1995
15
1996
%R
1997
1998
10
1999
2000
5
2001
2002
2003
0
Erythromycin
Clindamycin
Tetracycline
Figure 4.10. Resistance rates (resistant isolates in percent of
all Escherichia coli isolates) for six different antibiotics
1996-2003.
* Between 1996-2001 fluroquinolone resistance was detected with Norfloxacin,
from 2002 with Nalidixic acid.
%R
1996
25
1997
20
1999
15
2001
10
2002
5
2003
0
Ampicillin
Mecillinam
Cefadroxil
Nitrofurantoin
Quinolones *
Trimetoprim
Figure 4.11. Resistance rates (% R and I) to fluroroquinolones in Escherichia coli in Europe
2003. Data from EARSS (www.earss.rivm.nl).
Portugal (743)
Italy (669)
Malta (90)
Spain (2640)
Israel (773)
Bulgaria (155)
Slovakia (238)
Romania (50)
% resistant
% intermediate
Hungary (812)
Germany (217)
Belgium (174)
Austria (896)
Luxembourg (226)
Czech rep. (1764)
Slovenia (401)
Greece (507)
Ireland (950)
Sweden (3120)
Croatia (547)
Netherlands (848)
Poland (120)
Finland (1372)
Estonia (87)
0
5
10
15
Proportion of isolates (%)
20
25
30
Figure 4.12. Resistance rates (resistant isolates in percent of all
Pseudomonas aeruginosa isolates).
20
1984, MIC
1994, MIC
1994, DD
2003, DD
%
15
10
5
0
Gentamicin
Tobramycin
Ceftazidim
Imipenem
Meropenem Ciprofloxacin
Figure 4.13. Tuberculosis in Sweden 1991-2003.
Number of cases confirmed by culture and number of
whom with reported drug resistance.
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
700
600
500
400
300
200
100
0
TB total
Culture
Resistant
Figure 4.14. Annual number of cases with MDR-TB
related to national origin.
MDR Born abroad
MDR Born in Sw
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
10
8
6
4
2
0