1 / 55

Antibiotic policy to prevent resistance development

Antibiotic policy to prevent resistance development. Inga Odenholt Associate professor Department of Infectious Diseases, Malmö Lund University, Sweden. Antibiotic Resistance - THE RESULT OF A GLOBAL FAILURE . Antibiotic resistance. New treatment options.

kalyca
Télécharger la présentation

Antibiotic policy to prevent resistance development

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Antibiotic policy to prevent resistance development Inga Odenholt Associate professor Department of Infectious Diseases, Malmö Lund University, Sweden

  2. Antibiotic Resistance -THE RESULT OF A GLOBAL FAILURE

  3. Antibiotic resistance New treatment options

  4. Introduction of New Antibiotic Classes Oxazolidinones Trimetoprim Streptogramins Quinolones Lincosamides Chloramphenicol Cephalosporins Tetracyclines Macrolides Glycopeptides Aminoglycosides Penicillins Sulphonamides 1930´s 1940´s 1950´s 1960´s 1970’s 1980´s 1990´s 2000´s

  5. How to combat the increasing resistance?

  6. STRAMA Swedish Strategic programme for The Rational use of Antimicrobial Agents and Surveillance of Resistance www.strama.org

  7. How it all started • Increasing incidence of Pc-resistant pneumococci (PRP) in Southern Sweden from ~2% to 8-15% in early 1990s • Deterring international experiences • Who is responsible for action? • Discussion between competent authorities and professional organizations resulted in the formation of a national network for the combat of antibiotic resistance (1994)

  8. STRAMA National Group Swedish Medical Association Swedish Institute for Infectious Disease Control National Board of Health and Welfare Medical Products Agency National Corporation of Swedish Pharmacies Swedish Society for Hospital Hygiene and Infection Control The Swedish Federation of County Councils Corporation of County Medical Officers Swedish Association of Local Authorities The Swedish Network of Pharmacoepidemiology National Veterinary Institute The Swedish Board of Agriculture

  9. STRAMAPrimary objectives 1.To create a cross-sectorial national forum to - share information - formulate national strategies - support an initiate research activities - collaborate with media 2. To stimulate the formation of regional STRAMA - groups in every county

  10. STRAMA 1995-1999 Voluntary basis 2000-2002 Supported by the Swedish Government with 320.000 EUR yearly 2003 Funding increased to 800.000 EUR

  11. Examples of Goals for STRAMA (out-patients) • 1.To follow the usage of antibiotics and the • pattern of resistance at the national/regional levels • 2. To implement therapeutic guidelines and • intervention programmes • 3. To give feed-back to prescribers • 4. Cooperation with media • In order to reduce inappropriate antibiotic use

  12. Antibiotic consumption on a national levelSwedish Diagnosis-Antibiotic Prescribing study 2000 and 2002

  13. Five counties, 1.3 mil inhabitants • chosen to reflect the country’s antibiotic utilisation • 140 primary care centres, 600 GPs • One week in November • Recruitment through local STRAMA groups • Anonymous

  14. Antibiotics for urinary tract infections in the 2000 and 2002 STRAMA Diagnosis-antibiotic prescribing study

  15. Antibiotic consumption on a regional level Antibiotics in the county of Skåne 6 5 4 3 2 1 DDD / 1000 inv o dag 0 1999 2000 2001 2002 2003 2004 2005 År Tetracyclins Amoxicillin Penicillin V Cephalosporins Macrolids

  16. Antibiotics age group 0-6 years, municipalities in Sweden with the highest and lowest consumption, 2002.

  17. Resistance pattern

  18. Feed-back to the prescribers Consumption of fluoroquinolones in 4 districts Uppsala CountyThe effect of prescriber feed-back and educational outreach(DDD/1000 inhabitants/day)

  19. Consumption of fluoroquinolones in 4 districts Uppsala CountyThe effect of prescriber feed-back and educational outreach(DDD/1000 inhabitants/day)

  20. Conclusions • Knowing the national and regional use of antibiotics and the national and regional resistance pattern Interventions e.g. Therapeutic guidelines, education on a local level • Continuous efforts have led to changes in prescribing patterns (e. g. reduced use of quinolones in uncomplicated UTI, decreased use of of antibiotics in total; 20% in 8 years)

  21. Treatment guidelines

  22. STRAMA in hospitals The point-prevalence study • During 2 weeks in November 2003 and 2004 all patients in appr. 80% of the hospitals in Sweden were registered • 54 hospitals were included • 434 departments • 13536/11 348 patients • 30.9/31.8 % of the patients were treated with antibiotics

  23. The point-prevalence study • The aims of the study were to describe the use of antibiotics in Swedish hospitals • Indications/Diagnoses • Choice of antibiotics. Correct or not? • Dose • Community-acquired or nosocomial infections • Infections related to foreign-body devices

  24. Diagnoses Central nervous system Ophthalmic infections Mouth and throat Upper respiratory tract Bronchitis Pulmonary infections Cardiovascular system Gastrointestinal upper Gastrointestinal lower Gastrointestinal transmissible diseases Liver/bile duct/pancreas/spleen Skin and soft tissue Bone and joint Urinary bladder, cystitis Kidney, pyelonephritis, febrile urinary tract infection Genitalia Sepsis Indication not specified Indication unclear

  25. The point-prevalence study • Of all patients in the hospitals, antibiotic treatment was initiated • In 17% due to community-acquired infections • In 9% due to nosocomial infections • In 6% as prophylaxis

  26. Percentage of antibiotic treated patients per speciality; PPS 2003 och 2004. 2003: tot 4178 treated of 13 536 patients 2004: tot 3622 treated, of 11 348 ipatients 90% PPS 2003 80% PPS 2004 70% 60% 50% Andel behandlade/inneliggande patienter 40% 30% 20% 10% 0% ögon urologi geriatrik onkologi hudklinik neurologi akutklinik kardiologi kärlkirurgi hematologi barnkirurgi gynekologi handkirurgi njurmedicin lungmedicin reumatologi barnmedicin neurokirurgi thoraxkirurgi allm kirurgi med rehab plastikkirurgi endokrinologi neonatalavd neuro rehab BB/förlossning barnhabilitering infektionsklin öron-näsa-hals Alla specialiteter gastroenterologi allm internmed ortopedisk kirurgi transplantations kirurgi

  27. What antibiotics were used?

  28. Too much quinolones and cephalosporins!

  29. CID, 2004;38 (suppl 4): 341-345

  30. SANT-study Swedish Antibiotic Nursing home Trial

  31. Aims of the study • To describe and evaluate the treatment of infections in elderly patients in nursing homes

  32. Results of the registration • 58 nursing homes with 2752 patients • 890 infection registrations • Mean age of 86 years. • Appr. 2/3 were women

  33. Results • 43% of the patients had received antibiotics the past 3 months • 33% had had the same infection the past 3 month • Urinary tract infections was the most common diagnosis (60 %). Thereafter skin- and soft tissue infections (15 %), pneumonia (15 %) and others (10 %). • In 86 % of all registered infections antibiotics were initiated

  34. Treatment of UTIs • 89 % of the patients received antibiotics • >50% of the patients had got a UTI diagnosis the past 3 month and > 50% had received antibiotics the past 3 month

  35. What did we learn? • Earlier studies have shown that appr. 50% of patients in nursing homes have asymptomatic bacteriuria • A majority of these patients receive antibiotics, which is not recommended

  36. Hospital-acquired infections

  37. Asymptomatic patients with or without indwelling catheters should not be treated with antibiotics

  38. Antibiotic prophylaxis

  39. Too long prophylaxis! • One dose before • Transurethral prostate resection • Transrectal prostate core biopsy • Surgery with bowel substitute • Opening of the urinary tract, i.e. radical • prostatectomy

  40. Conclusions • Too much quinolones and cephalosporins in the hospitals • Too much quinolones on not recommended indications (e.g. lower UTIs in women) • Too much antibiotic treatment for urinary tract infections in asymptomatic patients • Too much antibiotic treatment for urinary tract infections in patients with catheters • Too long prophylaxis in surgery

More Related