Escolar Documentos
Profissional Documentos
Cultura Documentos
prescribing
Arjana Tambi Andraevi
University Hospital for Infectious Diseases Dr. F. Mihaljevi
Zagreb
Slika bacteria resistant to
antibiotics
Antibiotic Resistance Control in Croatia
3.5
3.0
2.5
2.0
Others*
Quinolones J01M
Tetracyclines J01A
0.5
Cephalosporins J01D
Penicillins J01C
0.0
FI FR HR LU PL BE GR EE SI MT DK SK HU SE NO
MRSA in 2007
K. pneumoniae
3rd Generation Cephalosporin resistance, EARSS 2007
P. aeruginosa
Carbapenem resistance, EARSS 2007
Outpatient antibiotic use in 25 European countries in 2003*
Others
30 Sulfonamides (J01E)
Tetracyclines (J01A)
25 Quinolones (J01M)
DDD / 1000 inabitants / day
Macrolides (J01F)
Cephalosporins (J01D)
20
Penicillins (J01C)
15
10
0
Luxembourg
Finland
Portugal
Hungary
Norway
Poland
France
Croatia
Czech Rep.
Germany
Austria
Ireland
Sweden
Denmark
Spain
UK
Belgium
Netherlands
Estonia
Iceland
Slovakia
Slovenia
Italy
Israel
Greece
* For Iceland total data are use; for Poland 2002 data are used.
Streptococcus pneumoniae
Penicillin non-susceptibility, EARSS 2007
Escherichia coli
Fluoroquinolone resistance 2004
Escherichia coli
Fluoroquinolone resistance 2007
Can We Estimate Quality of Antimicrobial
Prescriptions from Consumption Data?
On a national level
Trends in consumption over the years
Success of interventions
Adherence to ISKRA national guidelines
In an individual hospital
Trends in consumption over the years
Success of interventions
Adherence to local guidelines
Definitions
Quality: degree to which a set of inherent
characteristics (of a process) fulfills requirements (ISO
9000)
Audit:
analysis of appropriateness of individual
prescriptions Gould IM et al. JAC 1994;34:21-42
Simple audits
Point prevalence, baseline
Intervention audits
Before and after
Performance audit criteria
Justification of the prescription
Are the criteria for infection met
Is there an indication for any antimicrobial drug
Choice of drug
More effective alternative
Less toxic alternative
Less expensive alternative
Narrower spectrum alternative
Dosing, route of administration
Switch from i.v. to oral
Duration of treatment, timing
Surgical prophylaxis
Empirical therapy
JWM van der Meer, I Gyssens CMI, 2001 // I Gyssens, Int J Antimicrob Agents, 2001
Choice of drug
Empiric therapy
most likely causative microorganism
surveillance data on local sensitivity patterns
local guidelines for clinical syndromes
drug availability and prompt administration
Definitive therapy
Adjustment of the initial antimicrobial therapy, streamlining
Good communication with the microbiology laboratory from
request of the test to interpretation and application of the
results
Who should perform audits
Clinical microbiologists
Infectious diseases clinicians
Clinical pharmacists / clinical
pharmacologists
20 hospitals participated
ESAC II
Hospital Care
Subproject
2006
Lenghth of pre-operative prophylaxis in surgical
specialities
ESAC II Hospital Care Subproject, 2006
100
90
80
70
60
50
40
30
20
10
0
l
s.
s.
gy
s.
.
cs
s
y
s.
s.
ta
ls
ric
og
o
tic
ar
to
ic
c
oo
di
ra
ur
ia
et
ol
ac
ae
ul
as
ne
ol
ne
rd
st
ec
sc
or
op
ur
pl
ge
ca
ob
na
va
th
th
gy
or
55% of patients on 3%
antibiotic therapy 55%
43% of patients without 43%
antibiotic therapy
3% medical prophylaxis
25
% 20
15
10
t
e
ct
th
is
t
is
r
s
ia
NS
c
in
ve
su
iti
ra
ps
tra
rit
ou
on
jo
hr
C
fe
tis
lt
e
se
m
&
ry
nt
ep
a
eu
ft
in
e
to
ne
on
so
ro
t
pn
ra
es
bo
el
st
pi
&
t
py
ga
in
s
in
re
ro
sk
st
r
pe
ga
up
er
w
lo
Frequency of antibiotic prescribing
University Hospital for Infectious Diseases
Point Prevalence Study, 2006
ESAC II Hospital Care Subproject, 2006
Indication for specific antibiotic use
University Hospital for Infectious Diseases
Point Prevalence Study, 2006
ESAC II Hospital Care Subproject, 2006
Antibiotic Indications
Indication Antibiotics