www.lvn.se

Data for Action -

Swedish STRAMA as an example of successful local implementation of

AMR containment

Lars Blad Dep Med Officer for Comm Disease Control

Västernorrland County Chairman STRAMA Västernorrland

Sweden has a comparatively favourable situation of antibacterial resistance

2015-02-19 3

Resistance (R+I) to 3rd gen. Cephalosporins, E. coli K. pneumoniae

S. pneumoniae; non-susceptible to penicillin S. aureus; resistance to meticillin (MRSA)

Source: ECDC Antimicrobial resistance surveillance in Europe 2012

The sales of antibacterial drugs for systemic use in outpatient care (sales on prescriptions) 1987- 2013, prescriptions/1000 inhabitants and year, both sexes, different age groups.

Antibiotic outpatient sales in Sweden 1987 – 2013 for different age groups

The Swedish Experience

The Swedish Strategic Programme Against Antibiotic Resistance

http:// www.strama.se

Founded in 1995. The remit from the Government is to collaborate interdisciplinary on issues aiming to preserve the effectiveness of antibiotics.

•

•

•

The continuous work of the Strama group

Hospitals, Clinics,

PHC C:s

Pharmacy,Bact. lab,

Strama group

Prescription of AB:s /changed/

Local data on ABR, and AB use

Feed back of data; interventions

Resistance is influenced

Cultures are taken

Gathering of data

Analysis Epid.Int.

Lars Blad, 2009

Early demand-driven development of surveillance systems

ABR: • ResNet (1994/2002) • EARSS/EARS-Net • SmiNet (notifiables) • SveBar

AB use: •PHC: ”Week 47” (2000)

– PRIS/RAVE – ”PV-quality”

•Hospital: PPS (2003) – SAI/Anti-Infection Tool

•/ESAC, ESAC-Net/ •Individual drs data feedback (2012)

Example 1: pneumococci

• Signal/starting point: 90’s, increase of R in Southern Sweden

• Action necessary, broad measures: – Decrease ab pressure!

• Strama network is formed 1995 – Reduce spread!

• PRP: mandatory reporting, tracing, containment measures

• ”Anti-infection prophylaxis” for pre-school children

Fluoroquinolone-Resistant E.coli in Europe, 2001-2006

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

NO

(111

7)

EE (1

16)

SE (2

904)

FI (1

543)

IS (9

9)

NL

(214

0)

FR (4

610)

GR

(950

)

SI (5

26)

HR

(527

)

BE

(111

8)

LU (1

91)

UK

(187

9)

PL (1

53)

IE (1

184)

AT

(133

6)

CZ

(180

9)

BG

(155

)

HU

(723

)

IT (8

26)

IL (8

62)

PT (7

54)

ES (2

816)

DE

(104

0)

MT

(84)

CY

(57)

RO

(47)

TR (7

82)

Country code (average number of isolates reported per year)

% fl

uoro

quin

olon

e re

sist

ance

200120022003200420052006

Example 2: fluoroquinolone resistance in E. coli

ResNet 2007: E.coli

The continuous work of the Strama group

Hospitals, Clinics,

PHC C:s

Pharmacy,Bact. lab,

Strama group

Prescription of AB:s /changed/

Local data on ABR, and AB use

Feed back of data; interventions

Resistance is influenced

Cultures are taken

Gathering of data

Analysis Epid.Int.

Lars Blad, 2009

www.lvn.se

Figure by Ulf Lindahl, Strama Västernorrland

Kirurgkliniken, Sundsvall, antibiotika på recept

0

500

1000

1500

2000

2500

3000

2006-KV1

2006-KV2

2006-KV3

2006-KV4

2007-KV1

2007-KV2

2007-KV3

2007-KV4

2008-KV1

2008-KV2

2008-KV3

2008-KV4

DDD (definierade dygnsdoser)

J01MA02 - ciprofloxacin

J01CF05 - flukloxacillin

J01FF01 - klindamycin

J01AA02 - doxycyklin

J01CE02 - fenoximetylpenicillin(pcV)J01CA04 - amoxicillin

J01AA04 - lymecyklin

J01EE01 - sulfametoxazol +trimetoprimJ01MA06 - norfloxacin

J01CA08 - pivmecillinam

J01AA07 - tetracyklin

J01EA01 - trimetoprim

Surgical clinic, Sundsvall hospital, antibiotic prescriptions 2006 - 2008

DD

D, D

efin

ed D

aily

Dos

es

Kinoloner (J01M), totalt (recept och rekvisitioner)

0,0

0,2

0,4

0,6

0,8

1,0

1,2

1,4

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 (jan-aug)

DDD / 1000 inv / dag

RiketVästernorrland

Figure by Ulf Lindahl, Strama Västernorrland

Fluoroquinolone use (J01M), total (prescriptions and requisitions) D

DD

/100

0 in

habi

tant

s/da

y

Sweden Västernorrland

Sales of antibiotics commonly used to treat lower urinary tract infections in women (sales on prescriptions), age 18-79 years, 2000-2013, prescriptions/1000 women and year; Sweden

New recommendations from MPA and Strama

www.lvn.se

www.folkhalsomyndigheten.se/ www.reactgroup.org/