Antibiotic Management Team: a short survey

Transcription

1 Antibiotic Management Team: a short survey F. Van Bambeke and Paul M. Tulkens 1 Pharmacologie cellulaire et moléculaire Louvain Drug Research Institute & Centre de Pharmacie clinique Université catholique de Louvain Brussels, Belgium Based on the Belgian experience and on material kindly provided by Pharm. Caroline Briquet, Groupe de Gestion de l antibiothérapie, Cliniques univ. St Luc, Bruxelles, Belgium Dr C. Rossi, infectiologue - hygiéniste, CHU Ambroise Paré, Mons, Belgium Dr C. Potvliege, microbiologiste hygiéniste, CHU Tivoli, La Louvière, Belgium Prof. H. Goossens, microbiologist and "creator" of the Belgian Antibiotic Policy Coordination Commmittee", Antwerp, Belgium Prof. A. Simon, microbiologiste hygiéniste, Clin. univ. St-Luc, Bruxelles, Belgium Dr A. Apisarnthanarak, Division of Infectious Diseases, Thammasat University Hospital, Thailand. 1 member of the Association for the Prudent Use of Antibiotics (APUA: 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 1

2 Antimicrobial resistance is a major problem in hospitals You can act upon these parameters by a rational policy of use! Shlaes et al. Infect Control Hosp Epidemiol Apr;18(4): /10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 2

3 But what can we do? Local organism isolation (efficiency) susceptibility pattern and reporting Antibiotic Management Team Isolation and Hygiene Regional/National resistance and antibiotic consumption data setting up guidelines coordination 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 3

4 Antibiotic Management team Multidisciplinary team Infectious diseases MD microbiologist hygienist Delegate Clinical pharmacist trained in ID MD from departments using antibiotics pharmacist 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 4

5 Position within the hospital organization Medical Direction Medico-pharmaceutical Committee(MPC) formularium Committee for Hospital Hygiene (CHH) prevention of hospital infections epidemiology of resistance Antibiotic Management Team all activities described here Wards actual use of antibiotics Delegate for Antibiotic Management (1 to 4 persons, according to hospital size) Can be MD with clinical responsibilities MD/PharmD with laboratory activities (microbiology) Pharmacist Must follow a training organized by the Ministry of health in cooperation with Universities report inform dialogue 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 5

6 Priority tasks Mandatory interventions Hospital formularium for antibiotics (with the MPC) Required interventions Guidelines (for the wards) Local epidemiology (in collaboration with the CHH) Priority interventions Evaluation of consumption (in collaboration with Pharmacy) Link between consumption and epidemiology Providing advice about antibiotic use (for all hospital) Limitation and control of antibiotic usage (in collab. with MPC) Staff education (all wards) Annual report to the "Belgian Antibiotic Policy Coordination Committee" (Ministry of Health) 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 6

7 Financial support Range: 10,000-81,700 euro per hospital according to number of beds Annual budget: 3,609,208 euro (National Budget) mainly to cover the costs of hiring the Delegates of the Antibiotic Management Teams) 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 7

8 How are new Antibiotic Management Teams set up? 1. Determine human resources that are needed and available 2. Describe the current situation infectiologist pharmacist microbiologist hygenist MDs Analysis of prescriptions consumptions sample collection hygiene medical needs epidemiology 3. Establish the committee adapated to YOUR hospital 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 8

9 History project October 2002 AMTs in 37 acute care hospitals (Financing: Royal Decree 25 April 2002) July 2006 AMTs in 61 acute care hospitals (Financing: Royal Decree 10 November 2006) July 2007 AMT in all acute care hospitals and chronic care hospitals with >150 beds (Financing: Royal Decree 19 June 2007) (Tasks: Royal decree 12 February 2008) 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 9

10 Successes and Difficulties of the antibiotic management teams accepted as a reference in the hospital for evaluation of consumption prescription habits detection of inappropriate use reminding of guidelines Diffusion of information Communication Data availability unlinked softwares (laboratory vs. pharmacy) Heaviness of evaluation 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 10

11 Surveillance of ESBL-producing Enterobacter aerogenes in Belgian hospitals Moy.'E.a. ESBL+/E.a.(%) N=60 70 hospitals N=60 70 hospitals 2,3 2,2 1,9 2,3 2,1 2,4 2,6 2,1 36,6 34,9 29,2 37, ,5 41,5 30,7 2002/2 2003/1 2003/2 2004/1 2004/2 2005/1 2005/2 2006/1 2,5 42,9 2006/2 1,6 1,7 1,4 1,3 28, ,5 2007/1 2007/2 2008/1 2008/2 3 2,5 2 1,5 1 0,5 0 Moy. E.a. ESBL+/1000 adm BAPCOC effect? (Implementation of the Antibiotic Management Teams) Hand hygiene National campagnes? BICS guidelines for infection control of MRSA in hospitals? Périodes de surveillance Proportion d'e.a., ESBL+ Incidence d'e.a., ESBL+ Decrease in proportion / incidence of ESBL+ E. aerogenes since 2006/2 No difference in incidence by hospital nbr of bed size 2,5 fold higher incidence in hospitals with DMS >9 days ISP/WIV report 2008/2 11/10/2011 WBI - HUP cooperation - Bach Mai Hospital, Hanoi, Vietnam 11