Experiences from national – based surveillance systems

Slovenia

Prof. Milan Čižman, MD Head of ICM

Tom Bajec Data manager Slovenian Surveillance AM

consumption team

Demographic data

• Slovenia is a small country with 2.061.623 inhabitants according to the 2014 census

• Almost all inhabitants (>99%) have compulsory basic health insurance.

• No of hospitals 29 • No of hospital beds/1000 population in 2010:4.6

average EU 27: 5.3(2.7-8.3) • Surveillance of antibiotic consumption in hospitals

-1985,1990,1995-national

• -UMC-Lj –hospital and depart. level since1998

• -ESAC- 2001, national • -department- national consumption since 2006

Slovenia Hospital Characteristics

Type of hospital Number of hospitals

Teaching 2

General 10

Special - Psychiatric

- Maternity

- Rehabilitation

- Lung

- Oncology

- Ortopedic surgery

- Nursing

- Private

17 5

2

2

2

1

1

1

3

Annually tasks of consumption surveillance team

• Annually update of national list of AM products • Annually update of ATC and DDDs • Source of data: hospital pharmacists • In February each year the excel forms of all nationally available

antimicrobials are submitted to hospital pharmacists to fulfill (No of packages, units) for total hospital and separately for 5 departments

• The request for annual No of bed-days and No of admissions is sent to every hospital and NIPH

• The results of consumption using ATC/DDD methodology and expressed in DDD/100bed-days and DDD/100 admissions are latter available on the website

• Hospital pharmacist can compare their own data with the average data of the same type of hospital or department

Surveillance of hospital antibiotic consumption in Slovenia

Location: Ljubljana

Internet server Database server

ESACS

Database

Firewall

Internet

Location: Maribor

Hospital 1

Lokacija: Ljubljana

Hospital 2Hospital 3

Location

User x

Use of antibiotics (J01) in Slovenia 2008-2013 2008 2009 2010 2011 2012 2013

No of beds 9 587 9 389 9 367 9 493 9 349 9 377

No of

admissions

372 575 369 648 363 505 379 206 374 602 370 994

No of bed-

days

2 584 591 2 555 080 2 461 870 2 465262 2 446 111 2 439 895

Average

lenght of

stay

6.9 6.9 6.7 6.5 6.5 6.6

DDD/100

bed-days

48.25 50.95 52.26

50.43 47.88 47.65

DDD/100

admissions

342.28 365.33 356.38

327.88 312.64 313.36

DDD/TID 1.69 1.75 1.72 1.66 1.56 1.55

Source of data NIPH

Use of antibiotics (J01) in Slovenia 2008 vs 2013

2008 2013 ∆ % 2008 vs

2013

No of beds 9 587 9 377 - 2.2

No of admissions 372 575 370 994 - 0.5

No of bed-days 2 584 591 2 439 895 - 5.6

Average lenght of

stay

6.9 6.6 - 4.4

DDD/100 bed-days 48.25 47,65 - 1.3

DDD/100 admissions 342.28 313,36 - 8.5

DDD/TID 1.69

1.55 -8.3

Cost(EUR)

N=24

21 922 150 12 442 584 -43.3

Consumption (DDD/100 admissions) of antibiotics in Slovenia, Denmark, Sweden and the Netherlands in 2011-2013

Country Hospitals 2011 2012 2013

Slovenia All 328 313 313

Slovenia university +

general

308 333 325

Denmark1 somatic 283 304 309

Sweden2 somatic, 273 279 265

The

Netherlands3

72/91hosp.

teaching +

general

306 296 NA

NA – not available, 1Danmap, 2Swedres, 3Nethmap

Total use of antibiotics (DDD/100bed -days) according to the type of hospital 2013 - 2012

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Hospital use of cephalosporins in Slovenian hospitals 1997-2013 (DDD / 100 bed-days)

Consumption (DDD/100 adm) of cephalosporins in Slovenian hospitals in 2013

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Cephalosporin 3. gen (J01DD)

Cephalosporin 1. gen (J01DB)

Cephalosporin 2. gen (J01DC)

Cephalosporin 4. gen (J01DE)

Hospital use of carbapenems in Slovenian hospitals 1997-2013 (DDD / 100 bed-days)

Consumption of antibiotics (DDD/100 bed-days) in different

deparments Slovenia 2013

0

50

100

150

200

250

300

350

MICU SICU MxICU Surgery Medicine Gynecology Paediatrics

40,40 40,20 35,31

33,35 32,67

29,85 29,55 28,35 26,49

25,92 25,73 18,74

26,14 22,08 20,28

25,20 31,02

22,48 28,35 28,66 29,89

24,20 32,36 24,94

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

LJ CE JES NM BRE MB IZ SG TRB PT MS NG

Consumption of antibiotics(DDD/100 bed-days) in University and General hospitals in Slovenia 2013

O

P

I

2,26 3,12

2,60

3,15

2,90

1,75

2,87 3,56

0,97

3,60

2,45 2,17

2,45 3,43

4,90

2,73

4,97

4,99

2,91 3,01

3,21

3,95

3,77 2,85

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

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J01MA02_P J01MA02_O

Paranteral vs oral use of ciprofloxacin in Slovenian hospitals 2013

33

25 24 24 23 22 18 17 17 17

14

34

7

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Hosptial costs(EUR) for antibiotics - per admission in Slovenian hospital and UKC-LJ 2013

J01 J02

Conclusion • Surveillance of antibiotic consumption in

Slovenia is compulsory

• Surveillance is at national ,hospital and department level

• The data are expressed in DDD/100 bed-days and DDD/100 admissions,POvs IV,costs

• ICM team audits hospitals with high total and high usage of CIA

• Future:correlation antibiotic use vs resistance case-mix,electronic prescriptions,split inpatients/outpatients etc