ECDC activities on antimicrobial resistance & healthcare-associated infections (ARHAI Programme) Ülla-Karin Nurm, ECDC Tallinn, 13 May 2013
What is the European Union? 27 Member States 24 official languages > 500 million inhabitants (per country: 420,000 81.8 million) 25,200 GDP/capita (per country : 4,800 82,700) A patchwork of cultures! Source: Eurostat, 2012.
Healthcare resources in the EU %GDP for healthcare: approx. 6 to 11% Physicians: 27 to 200 per 100,000 inh. Nurses: 327 to 1550 per 100,000 inh. Source: WHO Health For All online database.
Europe: cultural differences, but a healthy culture of benchmarking! Who makes fun of whom in Europe? Adapted from: Helsingin Sanomat, Finland
Healthcare-associated infections, antimicrobial resistance: Overlapping, but not identical Healthcareassociated infections Antimicrobial resistance Community-acquired infections
Antimicrobial Resistance and Healthcare- Associated Infections (ARHAI) Programme EARS-Net ESAC-Net HAI-Net Coordination Coordination Group Coordination Group CG + Business Meet. Joint Meeting of ARHAI Networks Ongoing surveillance Epidemic intelligence Interactive database Interactive database & Annual report & Annual report Inter-agency report (2013) EPIS AMR-HAI Interactive database & Reports EPIS AMR-HAI Point prevalence survey Point prevalence survey of HAI and antimicrobial use in acute care hospitals Indicators Antibiotic stewardship indicators Infection control indicators Ad-hoc studies / projects Carbapenemase survey (2013) HALT-2 C. difficile surv. Risk assessment : syst. reviews and guidance Carbapenemaseproducing Enterobacteriaceae Perioperative proph. & Antibiotic stewardship prog. Infection control prog. Communication European Antibiotic Awareness Day Contribution to WHO Hand Hygiene Day Training Short course on prevention and control of MDROs Infection control training needs
http://ecdc.europa.eu/en/activities/diseaseprogrammes/arhai/pages/index.aspx
Antimicrobial resistance A threat to patient safety Limited options for for treatment Each year, in EU/EAA: 2.5 million attributable extra hospital days Increased length Increased of length of hospital stays hospital stays 25,000 attributable deaths Increased patient morbidity and mortality Increased patient morbidity and mortality Source: ECDC, 2009. In: http://ecdc.europa.eu/en/publications/publications/0909_ter_the_bacterial_challenge_time_to_react.pdf
European Antimicrobial Resistance Surveillance Network (EARS-Net) Since 1999, as the European Antimicrobial Resistance Surveillance System (EARSS) financed by grants from the European Commission (DG SANCO) to the Dutch National Institute for Public Health and the Environment (RIVM), followed by a grant from ECDC until December 2009 Coordinated by ECDC since January 2010 27 EU Member States, Iceland and Norway Microbiology and epidemiology contact points in each country Coordination Group (European experts) Annual report (at ECDC: 2009, 2010, 2011) Interactive database (ECDC website) http://ecdc.europa.eu/en/activities/surveillance/ears-net/pages/index.aspx
Antimicrobial resistance in Europe, 2011: percentage of invasive isolates showing resistance Staphylococcus aureus, meticillin resistance (MRSA) Klebsiella pneumoniae, combined resistance* * Combined resistance: resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides Source: EARS-Net, 2012 The symbols and indicate a significant increasing or decreasing trend for the period 2008-2011, respectively. These trends were calculated on laboratories that consistently reported during 2008-2011.
Staphylococcus aureus: percentage of invasive isolates resistant to meticillin (MRSA); EU/EEA, 2008 2011 2008 2011 Source: EARS-Net, 2012 The symbols and indicate a significant increasing or decreasing trend for the period 2008-2011, respectively. These trends were calculated on laboratories that consistently reported during 2008-2011.
Escherichia coli: percentage of invasive isolates resistant to third-generation cephalosporins; EU/EEA, 2008 2011 2008 2011 Source: EARS-Net, 2012 The symbols and indicate a significant increasing or decreasing trend for the period 2008-2011, respectively. These trends were calculated on laboratories that consistently reported during 2008-2011.
Escherichia coli: percentage of invasive isolates resistant to fluoroquinolones; EU/EEA, 2008-2011 2008 2011 Source: EARS-Net, 2012 The symbols and indicate a significant increasing or decreasing trend for the period 2008-2011, respectively. These trends were calculated on laboratories that consistently reported during 2008-2011.
Klebsiella pneumoniae: percentage of invasive isolates with combined resistance*; EU/EEA, 2008 2011 2008 2011 *Combined resistance: resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides Source: EARS-Net, 2012 The symbols and indicate a significant increasing or decreasing trend for the period 2008-2011, respectively. These trends were calculated on laboratories that consistently reported during 2008-2011.
Klebsiella pneumoniae: percentage of invasive isolates resistant to carbapenems; EU/EEA, 2008 2011 2008 2011 Source: EARS-Net, 2012 The symbols and indicate a significant increasing or decreasing trend for the period 2008-2011, respectively. These trends were calculated on laboratories that consistently reported during 2008-2011.
European Surveillance of Antimicrobial Consumption (ESAC-Net) Since 2001, as the European Surveillance of Antimicrobial Consumption (ESAC) project financed by grants from the European Commission (DG SANCO) to the University of Antwerp, followed by grants from ECDC until June 2011 Coordinated by ECDC since July 2011 27 EU Member States, Iceland and Norway Contact points in each country Coordination Group (European experts) Data on antimicrobial consumption in the primary care sector and in the hospital sector Annual report and interactive database (March 2013) http://ecdc.europa.eu/en/activities/surveillance/esac-net/pages/index.aspx
Consumption of antibiotics for systemic use (ATC group J01) in the community*; EU/EEA, 2010 *in Defined Daily Doses per 1000 inhabitants and per day Greece and Iceland: includes both community and hospital sector Spain: reimbursement data that do not include over-the-counter sales without a prescription Source: ESAC-Net, 2012 The symbols and indicate a continuous increase or decrease for the period 2008-2010, respectively. These trends were reported only for countries that consistently reported during 2008-2010.
Carbapenem consumption* (for the large majority in hospitals); EU/EEA, 2007 2010 2007 *in Defined Daily Doses per 1000 inhabitants and per day 2010 Source: ESAC-Net, 2012 The symbols and indicate a significant increase or decrease between 2007 and 2010, respectively. These trends are indicated only for countries that reported relevant data for both 2007 and 2010.
Healthcare-Associated Infections surveillance Network (HAI-Net) Since 2000, as the HELICS project and then the IPSE project, both financed by grants from the European Commission (DG SANCO) to Claude Bernard University Lyon I, France Coordinated by ECDC since July 2008 Coordination Groups (European experts) and contact points in participating countries Modules: Surgical site infections: 13 countries HAI in intensive care units: 14 countries Point prevalence survey: 30 countries HAI in long-term care (HALT-2, outsourced): 24 countries Reports http://ecdc.europa.eu/en/activities/surveillance/hai/pages/default.aspx
Modern medicine: not possible without effective antibiotics Hip / knee replacement Organ transplant Cancer chemotherapy Intensive care Care of preterm babies
Main actions to prevent and control antibiotic resistance New antibiotics (with a novel mechanism of action, research, development) Infection control (hand hygiene, screening, isolation) Prudent use of antibiotics (only when needed, correct dose, correct dose intervals, correct duration)
Eurobarometer Opinion Poll, November-December 2009 Antibiotics kill viruses. True or false? % respondents with correct answer (i.e., false ): 36% (range: 14 73%) 61 73% 41 60% 31 40% 21 30% 14 20% Source: Special Eurobarometer 338 / 72.5 Antimicrobial resistance, Nov.-Dec. 2009.
http://antibiotic.ecdc.europa.eu
European Antibiotic Awareness Day, 2008-2012 2008 2009 2010 2011 2012 Materials for the general public Materials for primary care prescribers Materials for hospital prescribers and hospitals Matched Get Smart week in the U.S. and the campaign in Canada Patient stories and Euronews movie 37 countries participated Collaboration with WHO/Europe 43 countries participated Matched campaigns in the U.S., Canada and Australia For more information: Earnshaw S, et al. Euro Surveill 2009;14(30) & http://antibiotic.ecdc.europa.eu
Malta
European Antibiotic Awareness Day: images from national campaigns on the prudent use of antibiotics
Toolkit for hospital prescribers: information materials Web banner Advertorial Fact sheet Check list PPT Presentation Screen saver European Antibiotic Awareness Day http://antibiotic.ecdc.europa.eu
http://antibiotic.ecdc.europa.eu
http://antibiotic.ecdc.europa.eu