Hospital ID: 831. Bourguiba Hospital. Tertiary hospital

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1 Global Point Prevalence Survey of Antimicrobial Consumption and Resistance in hospitals worldwide Hospital ID: 831 Habib Bourguiba Hospital Tertiary hospital Tunisia Point Prevalence Survey Habib 2017 Bourguiba Hospital Tertiary hospital 2017 ASLM 2018 Basma MNIF Associate professor Laboratory of Microbiology Habib Bourguiba University Hospital, Sfax, Tunisia

2 Disclosures

3 Outline Background Methods Results Targets and actions Conclusion

4 Global-PPS : an innovative worldwide accessible web-based tool designed by the University of Antwerp, Belgium ( Standardized and simple approach Data collection on antibiotic prescription patterns and resistance in the hospital Data comparison, nationally and worldwide Identify targets to improve antibiotic prescribing Combat antibiotic resistance Continually improve healthcare quality

5 Participation to Global PPS according to UN macro geographical regions (2017)

6 G-PPS Habib Bourguiba Hospital (HBH), Sfax, Tunisia 450 beds

7 Evolution of third-generation cephalosporin resistance in Enterobacteriaceae in HB hospital % R K. pneumoniae E. coli ESBL spread

8 Evolution of carbapenem resistance in Enterobacteriaceae in HB hospital 60 % R 50 % imipenem resistance K. pneumoniae Carbapenemase spread SPREAD of NDM , ,5 0,1 0 0,6 1,

9 Evolution of carbapenem resistance in non fermenter Gram-negative bacilli in HB hospital 100 % R 90 A. baumannii P. aeruginosa , , , ,3 18,9 6,8 4,5 20,5 24,2 17,5 22,1 24,3 13,1 17, ,4 7 24,5 23,3 36, , Années

10 Poor hygiene Antibiotic misuse 10

11 Methods Global-PPS was carried out in Habib Bourguiba university hospital in Tunisia between November and December 2017 Protocol ( Data collection templates-paper forms : ward and patient forms All inpatients receiving an antimicrobial on the day of the point prevalence survey were included Informations collected : patients demographics antimicrobial agents indications for treatment quality indicators : Reason in note, Targeted treatment, use of biomarkers, microbiological data and MDROs Web-based data-entry, verification, validation and reporting through the G-PPS program

12 Antibiotic prevalence rates 127 among 320 hospitalized patients

13 Type of indication 1% 18% 36% CAI HAI Prophylaxis unknown 45%

14 Overall proportional antibiotic use (2017) other beta-lactams

15 Proportional use of other beta lactam antibacterials (2017)

16 The main antimicrobials prescribed Aciclovir Fluconazole Others ATB Macrolids Vancomycin Tigecycline Colistin Amikacin Gentamicin Metronidazole Ciprofloxacin Levofloxacin Other Beta-lactam Imipenem C3G Amoxicillin and enzyme inhibitor

17 Frequently used antibiotics for sepsis

18 Frequently used antibiotics for pneumonia

19 Frequently used antibiotics for surgical prophylaxis

20 Duration of surgical prophylaxis

21 Quality indicators of antibiotic use in HBH Quality indicators % Reason in notes 23,4 % Stop/review date documented 8,3 % Guidelines missing 78,1 % Multiple antibiotics 48,8 % Targeted treatment 22,0 % Treatment based on biomarker data 74.4 % (CRP)

22 Quality indicators of antibiotic use

23 MDRO detected 8 ESBL-producing Enterobacteriaceae 2 Ceftazidim-resistant P. aeruginosa 10 Carbapenem-resistant non fermenter Gramnegative bacilli (A. baumannii and P. aeruginosa) MRSA, VRE : 0

24 MDRO carriage prevalence Digestive carriage of MDRO for all the hospitalized patients : 48/190 = 25,26 % ESBL-carriers 8/190 = 4.2 % CPE-carriers High antibiotic selective pressure

25 Identified targets to improve quality of antimicrobial prescribing No local guidelines No notes in medical records Excessive use of broad-spectrum antibiotics Insufficient microbiological documentation of infection

26 Actions : Result interpretation reports sent to all participating wards (feedback) Team : a representative person from each ward, infectious disease specialists, microbiologists and pharmacists

27 Actions: Develop local guidelines Surgical prophylaxis Common HAI (sepsis, pneumonia, UTI) Education and practice changes

28 Conclusions Need to raise awareness and encourage development of local antibiotic prescribing guidelines Need for education and practice changes Need to reduce the selective pressure of broadspectrum antibiotics to control the dissemination of MDROs in the country Repeated PPS : assess the effectiveness of actions

29 Acknowledgments Laboratory of medical microbiology, vaccine and infectious diseases institute, university of Antwerp, Belgium All health workers who participated to the G- PPS Sponsor : BioMérieux, the sole sponsor of the G-PPS