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The Swedish Experience
Otto CarsProf. Infectious Diseases
Uppsala University HospitalSweden
The Global Challenge Antibiotics are losing their effect at a pace that was unforeseen just five years ago The pipeline of new drugs is empty
The Global Challenge Antibiotics are losing their effect at a pace that was unforeseen just five years ago The pipeline of new drugs is empty
ESBL (CTX-M) producing Enterobacteriaceae
2001-2002
Endemicity Sporadic reports
Endemicity Sporadic reports2005
2007
The consequences…….The consequences…….
Bloodstream infection: 43.5% of the children with Gram-negative bloodstream infection died in a Tanzanian study (Blomberg, 2007).
ESBL & MDR Gram-negatives: In Israel 3% of all fatalities in hospitals related to Gram-negative multiresistant nosocomial infections (Carmeli, 2006).
www.reactgroup.org
Clonal outbreak of av multiresistant Klebsiella pneumoniae Uppsala
University Hospital
The Current Paradox:
AntibioticResistance
DrugDevelopment
MorbidityMorbidityMortalityMortality
CostsCosts
Hip replacement
Transplants
Cancer chemotherapy
Infections in preterm babies
Overall objective To preserve effective antibacterial therapy
for the future
The Swedish Experience
The Swedish Strategic Programme Against Antibiotic Resistance
http:// www.strama.se
NATIONAL LEVELNational co-ordinating groupSurveillanceNational projects
LOCAL LEVEL Local co-ordinating groups Implementation Behavioural change
Intensive care
Hospital care
Nursing homes
Primary care
Day care centres
School children
Projects and interventions initiated in many areas
NATIONAL LEVELNational co-ordinating groupSurveillanceNational projects
LOCAL LEVEL Local co-ordinating groups Implementation Behavioural change
• Strama-groups were formed in every county.
• The County Medical Officers for Communicable
have a leading role in these groups which include
specialists from different medical fields
• The main objective is to evaluate the use
antibiotics and antibacterial resistance in the
region and to improve prescribing patterns
Strama-some examples of activities
•Local implementation of guidelines
•Sales statistics, Resistance data
•Feedback and audit
•Newsletter, website,
•Fund for local projects
•Educational activities “ Strama workshops”
Effect of prescriber feedback on consumption of fluoroquinolones
in four primary care districts of Uppsala County
00,20,40,60,8
11,21,41,61,8
Sweden
Distric
t 1
Distric
t 2
Distric
t 3
Distric
t 4
1995
1996
DD
D/1
00
0ín
h/d
ay
00,20,40,60,8
11,21,41,61,8
Sweden
Distric
t 1
Distric
t 2
Distric
t 3
Distric
t 4
199519961997
Effect of prescriber feedback on consumption of fluoroquinolones in four primary care districts of Uppsala County
DD
D/1
00
0ín
h/d
ay
Patient Prescriber
Authorities MEDIA
Awareness raising of all stakeholders through news media
UVI-medel till kvinnor, öppenvård
0
10
20
30
40
50
60
J01CA08 - pivmecillinam J01EA01 - trimetoprim J01XE01 - nitrofurantoin Kinoloner (norfloxacin + småcipro)
Re
cip
en
/10
00
/år
2000
2001
2002
2003
2004
2005
2006
2007
”Små cipro” avser ciprofloxacin 100 mg 6 resp 10 tabl, 250 mg 10 tabl och 500 mg 10 tabl.
Prescriptions of antibiotics for UTI (outpatients)
Fluoroquinolones
Total sales of Antibiotics in the Nordic Countries 1978-2006* D
DD
/100
0 in
habi
tant
s/da
y
-
5
10
15
20
25
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Iceland
Finland
Sweden
Norway
Denmark
*Excluding Metenamine. Before 1998 figures from Denmark do not include hospital use.
Possible success factors Multidisciplinary coordinating group- involving all stakeholders
Governmental support and mandate
Decentralised organisation and local ownership
Credible, scientifically based messages and actions
Clear communication and media strategy
Conclusions
It is possible to achieve a significant change in antibiotic use at the national level.
To be sustainable, political/financial support is needed.
Despite low antibiotic consumption resistance rates are incrasing
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