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European Antibiotic Awareness Day 2010: Prudent use of antibiotics in hospital settings

Outi Lyytikäinen / Terhi HulkkoTHL TATO TART

18.11.2010

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Sisältö• Keskeiset viestit - Key messages• Kampanjan iskulauseet - Campaign slogans• Lehtinen perusasioista - Fact sheet• Tarkistuslista - Checklist for hospital prescribers• Uutta kuvamateriaalia - New campaign visuals• Diakuvia - Power point show

Key messages1. What is the problem with antibiotic resistance?2. How does the use of antibiotics contribute to the

problem?3. Why promote prudent use of antibiotics? 4. How to promote prudent use of antibiotics?

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What is the problem? (key message 1)• Antibiotic-resistant bacteria have become an everyday occurrence and

problem in hospitals across Europe (1). • 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 (2-3).

• Misuse of antibiotics is associated with an increased incidence of Clostridium difficile infections (4-5).

• The emergence, selection and spread of resistant bacteria is a threat to patient safety in hospitals because:

– Infections with antibiotic-resistant bacteria result in increased patient morbidity and mortality, as well as increased hospital length of stay (6-7).

– Antibiotic resistance frequently leads to a delay in appropriate antibiotic therapy (8).

– Inappropriate or delayed antibiotic therapy in patients with severe infections is associated with worse patient outcomes and sometimes death (9-11).

– The current pipeline for new antibiotics is limited and, if antibiotic resistance continues to grow, there will be no effective antibiotics for treatment (12).

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How does the use of antibiotics contribute to the problem? (key message 2)• Patients who are hospitalized have a high probability of receiving an

antibiotic (13) and 50% of all antibiotic use in hospitals can be inappropriate (4, 14);

• Misuse of antibiotics in hospitals is one of the main factors that drive development of antibiotic resistance (15-17);

• 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 the spectrum of antibiotic therapy is either too narrow or too

broad; – When the dose of antibiotic is either too low or too high compared to

what is indicated for that patient; – When the duration of antibiotic treatment is too short or too long; – When antibiotic treatment is not streamlined when microbiological

culture data become available.

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Why promote prudent use of antibiotics?(key message 3)• Prudent use of antibiotics can prevent the emergence and selection of

antibiotic-resistant bacteria (4, 17, 19-21). • Decreasing antibiotic use has been shown to result in decreasing incidence

of Clostridium difficile infections (4, 19, 22).

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How to promote prudent use of antibiotics?(key message 4)• Multifaceted strategies which include use of ongoing education, use of

evidence-based hospital antibiotic guidelines and policies, restrictive measures and consultations from infectious disease physicians, microbiologists and pharmacists, may result in better antibiotic prescribing practices and decreasing antibiotic resistance (4, 19, 23).

– Monitoring of hospital antibiotic resistance and antibiotic use data has been shown to provide useful information to guide empirical antibiotic therapy in severely ill patients (24)

– Correct timing and optimal duration of antibiotic prophylaxis for surgery is associated with a lower risk of surgical site infections (25) and lower risk of emergence of antibiotic-resistant bacteria (26)

– Studies show that, for some indications, shorter rather than longer duration of treatment can be administered without differences in patient outcome and this has also been associated with lower frequencies of antibiotic resistance (15, 27-28).

– Taking microbiological samples before initiating empiric antibiotic therapy, monitoring culture results and streamlining antibiotic treatment based on culture results is a means to reduce unnecessary antibiotic use (29).

Target groups and key messages• General key messages• Hospital prescribers (doctors and nurses)• Hospital management• Hospital pharmaceutical committee/antibiotic

stewardship committee• Hospital pharmacists

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Campaign slogans• Antibiotics - handle with care

– Misuse leads to antibiotic resistance • Target antibiotic therapy

– Take cultures before starting antibiotic therapy• Take that sample

– Take cultures before starting antibiotic therapy• Have you consulted the antibiotic expert in your

hospital?– Use antibiotics prudently to keep them working

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Fact sheet(1. sivu)

Antibiotic resistance Facts and figures

Fact 1. Antibiotic resistance is an increasingly serious public health problem in Europe

The emergence, spread and selection of antibiotic-resistant bacteria is a threat to patient safety in hospitals1, 2 because:

• Infections with antibiotic-resistant bacteria result in increased patient morbidity and mortality, as well as increased hospital length of stay4-5;

• Antibiotic resistance frequently leads to a delay in appropriate antibiotic therapy6;

• Inappropriate or delayed antibiotic therapy in patients with severe infections is associated with worse patient outcomes and sometimes death7-9.

Fact 2. Misuse of antibiotics in hospitals is one of the factors driving antibiotic resistance

Patients who are hospitalised have a high probability of receiving an antibiotic10 and 50% of all antibiotic use in hospitals can be inappropriate2, 11. Misuse of antibiotics in hospitals is one of the main factors driving development of antibiotic resistance12-14.

Misuse of antibiotics can include any of the following15:

• 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.

Figure 1. Trends of antibiotic resistance in S. pneumoniae and E. Coli as an EU population weighted average, 2002-2008. Source: EARSS, 20091 [Instructions on how to adapt the graph to national data are included in the guidance note]

Fact 3. Benefits of prudent antibiotic use

Prudent use of antibiotics can prevent the emergence and selection of antibiotic-resistant bacteria2, 14, 16-18 and decreasing antibiotic use has been shown to result in lower incidence of Clostridium difficile infections2, 16, 19.

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Pro

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Penicill in-non susceptib le S. p neumoniae (EU pop.-weig htedaverage)Erythromycin-resistan t S. pneumoniae (EU po p.-weighted average)

Fluoro quino lone-resistant E. coli (EU pop.-weighted averag e)

Th ird-g en. cephalospo rin-resistant E. coli (EU po p.-weightedaverage)Penicill in-non susceptib le S. p neumoniae (Au stria)

Erythromycin-resistan t S. pneumoniae (Austria)

Fluoro quino lone-resistant E. coli (Austria)

Th ird-g en. cephalospo rin-resistant E. coli (Austria)

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Fact sheet(2. sivu)

Antibiotic resistance

Facts and figures

References 1. European Antimicrobial Resistance Surveillance System [database on the Internet]. RIVM. 2009 [cited March 30, 2010]. Available from: http://www.rivm.nl/earss/database/. 2. 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):CD003543. 3. Bartlett JG, Onderdonk AB, Cisneros RL, Kasper DL. Clindamycin‐associated colitis due  to a  toxin‐producing species of Clostridium  in hamsters.  J  Infect Dis. 1977 Nov;136(5):701‐5. 4. Cosgrove SE, Carmeli Y. The  impact of antimicrobial  resistance on health and economic outcomes. Clin Infect Dis. 2003 Jun 1;36(11):1433‐7. 5. 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. 2009 Oct 15;49(8):1175‐84. 6. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999 Feb;115(2):462‐74. 7. 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. 2000 Jul;118(1):146‐55. 8. Lodise TP, McKinnon PS, Swiderski L, Rybak MJ. Outcomes analysis of delayed antibiotic treatment for hospital‐acquired Staphylococcus aureus  bacteremia.  Clin  Infect Dis.  2003  Jun  1;36(11):1418‐23.  9. 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. 1996 May;22(5):387‐94. 10. 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 2006. Clin Infect Dis. 2009 Nov 15;49(10):1496‐504. 11. Willemsen I, Groenhuijzen A, Bogaers D, tuurman A, van Keulen P, Kluytmans J. Appropriateness of antimicrobial therapy measured by repeated prevalence surveys. Antimicrob Agents Chemother. 2007 Mar;51(3):864‐7.  12. Singh N, Yu VL. Rational empiric antibiotic prescription in the ICU. Chest. 2000 May;117(5):1496‐9. 13. Lesch CA, Itokazu GS, Danziger LH, Weinstein RA. Multi‐hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis. 2001 Nov;41(3):149‐54. 14. Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of  imipenem correlates with beta‐lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2002 Sep;46(9):2920‐5. 15. 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. 1992 Nov;30(5):724‐7. 16. 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. 2003 Sep;24(9):699‐706. 17. 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. 1999 Feb;43(2):261‐6. 18. 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):973‐8. 19. 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. 2007 May;59(5):990‐5. 20. 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. 1999 Jul;29(1):60‐6; discussion  7‐8.  21. 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. 2006 Sep;130(3):787‐93. 22. Steinberg JP, Braun BI, Hellinger WC, Kusek L, Bozikis MR, Bush AJ, et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial  to Reduce Antimicrobial Prophylaxis Errors. Ann Surg. 2009  Jul;250(1):10‐6. 23.Chastre  J, Wolff M, Fagon  JY, Chevret S, Thomas F, Wermert D, et al. Comparison of 8 vs 15 days of antibiotic  therapy  for ventilator‐associated pneumonia  in adults: a randomized trial. Jama. 2003 Nov 19;290(19):2588‐98. 24.Ibrahim EH, Ward S, Sherman G, Schaiff R, Fraser VJ, Kollef MH. Experience with a clinical guideline for the treatment of ventilator‐associated pneumonia. Crit Care Med. 2001  Jun;29(6):1109‐15.25. 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. 1997 Jul;156(1):196‐200.

Figure 3. Rates of nosocomial Clostridium difficile, expressed per 1,000 patient-days, before and after implementation of the antibiotic management program. Source: Carling P, et al 200316.

Fact 4. Multifaceted strategies can result in prudent antibiotic use

As part of multifaceted strategies certain measures may result in better antibiotic prescribing practices and decreasing antibiotic resistance in hospitals. Multifaceted strategies include use of ongoing education, evidence-based hospital antibiotic guidelines and policies, restrictive measures and consultations from infectious disease physicians, microbiologists and pharmacists2, 16, 20.

Measures to promote prudent use of antibiotics include16, 20, 21, 22:

• Continuous education of prescribers and specialists included in comprehensive hospital strategies2;

• Evidence-based hospital antibiotic guidelines and policies2, 16, 20;

• Monitoring of hospital antibiotic resistance and antibiotic use data to guide empiric antibiotic therapy in severely ill patients21;

• Administering the correct timing and optimal duration of antibiotic prophylaxis for surgery22;

• For some indications, using shorter rather than longer duration of treatment12, 23-24;

• Taking microbiological samples before initiating empiric antibiotic therapy, monitoring culture results and streamlining antibiotic treatment based on the culture results25.

Figure 2. 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. Source: Carling P, et al 200316. *NNIS is now the National Healthcare Safety Network (NHSN).

European Centre forDisease Prevention and Control (ECDC) Tel: +46 (0)8 5860 1000 Email: EAAD@ecdc.europa.eu

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Placeholder for national health ministry logo

Rates per 1000 patient days

Rates per 1000 patient days

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Checklist for hospital prescribers

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New campaign visuals

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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

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Antibiotic resistance - a patient safety issue

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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.

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2002 2003 2004 2005 2006 2007 2008

Prop

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Penicillin-non susceptible S. pneumoniae (EU pop.-weighted average)

Erythromycin-resistant S. pneumoniae (EU pop.-weighted average)

Fluoroquinolone-resistant E. coli (EU pop.-weighted average)

Third-gen. cephalosporin-resistant E. coli (EU pop.-weighted average)

Trends in antibiotic resistance (invasive infections), 2002-2008. Source: European Antimicrobial Resistance Surveillance System (EARSS), 2009.

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2002 2007

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), 2008.

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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

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ount

ries

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Antimicrobial resistance in gram-negative bacteria, EU, 2007: already high or increasing

Country with a significant increase (2005-2007)Country with a significant decrease (2005-2007)

Carbapenem-resistant Pseudomonas aeruginosa (%)

3rd-gen. ceph.-resistant Klebsiella pneumoniae (%)3rd-gen. ceph.-resistant Escherichia coli (%)

Source: EARSS & ECDC, 2009No.

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Source: European Surveillance of Antimicrobial Consumption (ESAC), 2010. In: ECDC Annual Epidemiological Report 2010: in press.

Total outpatient antibiotic use in EU Member States, Iceland and Norway, 2008

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* 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)

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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 appropriateantibiotic therapy.3

– Inappropriate or delayed antibiotic therapy in patients with severe infections is associated with worse patient outcomes and sometimes death.4-6

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1. Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003 Jun 1;36(11):1433-7. 2. 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. 2009 Oct 15;49(8):1175-84. 3. Kollef MH, Sherman G, Ward S, Fraser VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest. 1999 Feb;115(2):462-74. 4. 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. 2000 Jul;118(1):146-55. 5. Lodise TP, McKinnon PS, Swiderski L, Rybak MJ. Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia. Clin Infect Dis. 2003 Jun 1;36(11):1418-23. 6. Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired pneumonia Study Group. Intensive Care Med. 1996 May;22(5):387-94.

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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].

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Why inappropriate use of antibiotics contributes to antibiotic resistance

- the “why”

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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 antibiotic10 and 50% [adapt to national figure where available] of all antibiotic use in hospitals can be inappropriate.11-12

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7. Singh N, Yu VL. Rational empiric antibiotic prescription in the ICU. Chest. 2000 May;117(5):1496-9. 8. Lesch CA, Itokazu GS, Danziger LH, Weinstein RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis. 2001 Nov;41(3):149-54. 9. Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2002 Sep;46(9):2920-5. 10. 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 2006. Clin Infect Dis. 2009 Nov 15;49(10):1496-504.11. 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):CD003543. 12. 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. 2007 Mar;51(3):864-7.

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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.13-14

• Misuse of antibiotics is also associated with an increased incidence of Clostridium difficile infections.15-17

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13. 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. 2002 Jun 4;136(11):834-44.14. 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. 2009 Oct;53(10):4264-9.15. 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. 15. 2005(4):CD003543.16. 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. 2003 Sep;24(9):699-706.17. 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. 2007 May;59(5):990-5.

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What is misuse of antibiotics?

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Misuse of antibiotics can include any of the following18:

• 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. 1992 Nov;30(5):724-7.

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Benefits of prudent use of antibiotics• Prudent use of antibiotics can prevent the emergence and selection of

antibiotic-resistant bacteria.19-23

• Decreasing antibiotic use have also been shown to result in lower incidence of Clostridium difficile infections.24-26

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.28

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19, 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):CD003543.20. Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2002 Sep;46(9):2920-5. 21, 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. 2003 Sep;24(9):699-706. 22. 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):973-8. 26. 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. 1999 Jul;29(1):60-6; discussion 7-8.

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How prudent use of antibiotics can be promoted in hospitals

- the “how”

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Multifaceted strategies can address and decrease antibiotic resistance in hospitals• Antibiotic prescribing practices and decreasing antibiotic

resistance can be addressed through multifaceted strategies including:29-31

Use of ongoing educationUse of evidence-based hospital antibiotic guidelines and policiesRestrictive measures and consultations from infectious disease physicians, microbiologists and pharmacists

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29. 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):CD003543.30. 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. 2003 Sep;24(9):699-706.31. 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. 1999 Jul;29(1):60-6; discussion 7-8.

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Measures that can decrease antibiotic resistance

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Measures that guide antibiotic prescribing are likely to decrease antibiotic resistance in hospitals.32-34 Such measures include:

Obtaining culturesTake appropriate and early cultures before initiating empiric antibiotic therapy, and streamline antibiotic treatment based on the culture results35

Monitoring local antibiotic resistance patternsBeing aware of local antibiotic resistance patterns (antibiograms) enables appropriate selection of initial empiric antibiotic therapy36

Consulting specialistsInvolve infectious disease physicians, microbiologists and pharmacists in your decisions about antibiotic therapy during your patient’s stay37-39

32, 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):CD00354333, 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. 2003 Sep;24(9):699-706.34, 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. 1999 Jul;29(1):60-6; discussion 7-8.35. 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. 1997 Jul;156(1):196-200.36. 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. 2006 Sep;130(3):787-93.

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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]

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Antibiotics - handle with care• Misuse of antibiotics leads to resistance40-42

• All hospital practitioners can play an active role in reversing the trend of antibiotic-resistant bacteria:– Take cultures before starting antibiotic therapy43

– Consult the hospital antibiotic expert44-46, [local antibiogram, and hospital antibiotic guidelines]

– Streamline antibiotic therapy based on culture results47

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40. Singh N, Yu VL. Rational empiric antibiotic prescription in the ICU. Chest. 2000 May;117(5):1496-9.41. Lesch CA, Itokazu GS, Danziger LH, Weinstein RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis. 2001 Nov;41(3):149-54.42. Lepper PM, Grusa E, Reichl H, Hogel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2002 Sep;46(9):2920-5.43, 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. 1997 Jul;156(1):196-200.44. 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):CD00354345. 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. 2003 Sep;24(9):699-706.47.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. 1999 Jul;29(1):60-6; discussion 7-8.

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European Antibiotic Awareness Day - a campaign to promote prudent use

of antibiotics

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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.

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European Antibiotics Awareness Day:Planned local activities

• [Insert planned local activities, highlighting where involvement by the audience of this presentation would be welcome]

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THANK YOU!

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

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