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[Insert Name of presenter] [Insert Name of hospital] Using antibiotics prudently - Hospital Prescriber Presentation.

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Presentation on theme: "[Insert Name of presenter] [Insert Name of hospital] Using antibiotics prudently - Hospital Prescriber Presentation."— Presentation transcript:

1 [Insert Name of presenter] [Insert Name of hospital] Using antibiotics prudently - Hospital Prescriber Presentation

2 Contents of this presentation Antibiotic resistance – a patient safety issue –Situation in Europe –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

3 Antibiotic resistance – a patient safety issue 3

4 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 hospitals across Europe. 4 Trends in antibiotic resistance (invasive infections), Source: European Antimicrobial Resistance Surveillance System (EARSS), 2009.

5 Methicillin-resistant Staphylococcus aureus (MRSA), blood and spinal fluid No data <1% 1-5% 5-10% 10-25% 25-50% >50% Source: European Antimicrobial Resistance Surveillance System (EARSS),

6 Methicillin-resistant Staphylococcus aureus (MRSA), EU, 2007: often high, but decreasing in many countries Country with a significant increase (2005–2007) Country with a significant decrease (2005 – 2007) MRSA (%) Source: EARSS & ECDC, 2009 No. of countries 6

7 Antimicrobial resistance in gram-negative bacteria, EU, 2007: already high or increasing Country with a significant increase ( ) Country with a significant decrease ( ) Carbapenem-resistant Pseudomonas aeruginosa (%) 3rd-gen. ceph.-resistant Klebsiella pneumoniae (%) 3rd-gen. ceph.-resistant Escherichia coli (%) Source: EARSS & ECDC, 2009 No. of countries 7

8 Source: European Surveillance of Antimicrobial Consumption (ESAC), In: ECDC Annual Epidemiological Report 2010: in press. Total outpatient antibiotic use in EU Member States, Iceland and Norway, * 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 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 Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis Jun 1;36(11): 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 Oct 15;49(8): Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest Feb;115(2): 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 Jul;118(1): Lodise TP, McKinnon PS, Swiderski L, Rybak MJ. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis Jun 1;36(11): 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 May;22(5):

10 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]. 10

11 Why inappropriate use of antibiotics contributes to antibiotic resistance – the why 11

12 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 antibiotic 10 and 50% [adapt to national figure where available] of all antibiotic use in hospitals can be inappropriate Singh N, Yu VL. Rational empiric antibiotic prescription in the ICU. Chest May;117(5): Lesch CA, Itokazu GS, Danziger LH, Weinstein RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis Nov;41(3): Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother Sep;46(9): 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 Clin Infect Dis Nov 15;49(10): 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):CD 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 Mar;51(3):864-7.

13 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) and highly-resistant Gram-negative bacilli Misuse of antibiotics is also associated with an increased incidence of Clostridium difficile infections 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 Jun 4;136(11): 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 Oct;53(10): 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 (4):CD 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 Sep;24(9): 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 May;59(5):990-5.

14 What is misuse of antibiotics? 14 Misuse of antibiotics can include any of the following 18 : 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. 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 Nov;30(5):724-7.

15 Benefits of prudent use of antibiotics Prudent use of antibiotics can prevent the emergence and selection of antibiotic-resistant bacteria Decreasing antibiotic use have also been shown to result in lower incidence of Clostridium difficile infections 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). Rates of nosocomial Clostridium difficile, expressed per 1,000 patient- days, before and after implementation of the antibiotic management program , 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):CD Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother Sep;46(9): , 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 Sep;24(9): 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): 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 Jul;29(1):60-6; discussion 7-8.

16 How prudent use of antibiotics can be promoted in hospitals – the how 16

17 Multifaceted strategies can address and decrease antibiotic resistance in hospitals Antibiotic prescribing practices and decreasing antibiotic resistance can be addressed through multifaceted strategies including: Use of ongoing education Use of evidence-based hospital antibiotic guidelines and policies Restrictive measures and consultations from infectious disease physicians, microbiologists and pharmacists 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):CD 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 Sep;24(9): 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 Jul;29(1):60-6; discussion 7-8.

18 Measures that can decrease antibiotic resistance 18 Measures that guide antibiotic prescribing are likely to decrease antibiotic resistance in hospitals Such measures include: Obtaining cultures Take appropriate and early cultures before initiating empiric antibiotic therapy, and streamline antibiotic treatment based on the culture results 35 Monitoring local antibiotic resistance patterns Being aware of local antibiotic resistance patterns (antibiograms) enables appropriate selection of initial empiric antibiotic therapy 36 Consulting specialists Involve infectious disease physicians, microbiologists and pharmacists in your decisions about antibiotic therapy during your patients stay , 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):CD , 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 Sep;24(9): , 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 Jul;29(1):60-6; discussion 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 Jul;156(1): 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 Sep;130(3):

19 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] 19

20 Antibiotics – handle with care Misuse of antibiotics leads to resistance All hospital practitioners can play an active role in reversing the trend of antibiotic-resistant bacteria: –Take cultures before starting antibiotic therapy 43 –Consult the hospital antibiotic expert 44-46, [local antibiogram, and hospital antibiotic guidelines] –Streamline antibiotic therapy based on culture results Singh N, Yu VL. Rational empiric antibiotic prescription in the ICU. Chest May;117(5): Lesch CA, Itokazu GS, Danziger LH, Weinstein RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis Nov;41(3): Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother Sep;46(9): , 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 Jul;156(1): 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):CD 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 Sep;24(9): 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 Jul;29(1):60-6; discussion 7-8.

21 European Antibiotic Awareness Day – a campaign to promote prudent use of antibiotics 21

22 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. 22

23 European Antibiotics Awareness Day: Planned local activities [Insert planned local activities, highlighting where involvement by the audience of this presentation would be welcome] 23

24 THANK YOU! For more information on data sources and references, please visit: –http://antibiotic.ecdc.europa.eu –[insert national website] 24


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