prof. dr. Bojana Beović, dr. med.

How To Improve ntibiotic Use In Hospitals prof. dr. ojana eović, dr. med. University Medical entre Ljubljana Slovenia

Evidence-based antibiotic. Team (II-III) III) stewardship 2. ollaboration with hospital infection control (III) 3. ollaboration with administration, medical staff leadership and local providers (III) 4. uthority, obtained by administration (III) 5. dministrative support (III) 6. ore strategies: audit with feedback (I), formulary restriction/pre-authorisation (II) Dellit TH, et al. IDS and SHE guidelines for developing an institutional program to enhance antimicrobial stewardship. ID 27; 44: 59.

Evidence-based antibiotic stewardship (cont d) 7. Elements as supplements Education (III, II) Guidelines, clinical pathways (I, III) ycling (II) Order forms (II) ombination (II, II) Streamlining and de-escalation escalation (II) Dose optimizing (II) Parenteral to oral (III) 8. Informaton technology (III, II) 9. omputer-based surveillance (II). linical microbiology (III). Outcome measures (III) Dellit TH, et al. IDS and SHE guidelines for developing an institutional program to enhance antimicrobial stewardship. ID 27; 44: 59.

MD per inh in 24: Slovenia 2.2, EU 3.2 (OED and Slovenian Medical hamber) MRS rate: 2: 2.4 % 27: 8.3% (ERSS, eovic, et al. Lancet 25) Outpatient consumption: 999: 2.27 DDD/TID 26: 4.8 DDD/TID (ES Study Group)

Situation in MR in Slovenia Intersectoral mechanism from 25 Strategy from 26 ntimicrobial committees in all general hospitals Hospital hygiene committes in all hospitals (by law from 999) Susceptibility data: ERSS and other national/international projects onsumption data: ES (all hospitals)

ES Report 26

onsumption of antibacterials for systemic use (J) DDD/ bed-days days in European countries ountry Slovenia Included hospitals 23 24 25 26 27 all 47.6 47.3 48.6 49.5 5.4 Slovenia Denmark Sweden The Netherlands teaching +general teaching +general 56.9 58. 59.3 58. 59.4 55. 58.2 63. 63.9 68.8* all? 5.8 53.5 58.9 6.2 NP 6 % 5.2 53.8 58.3 62.2 NP ourtesy of Čižman M.

7 Use of restricted and non-restricted antibacterials (J) in Tertiary are enter Ljubljana, Slovenia 998-27 T/WHO version 27 (DDD/ bed-days) Restricted Unrestricte 6 DDD/ ed-days 5 4 3 2 52, 55,33 56,9 54,3 58,3 58,5 57,28 55,53 56,77 57,33 3,6 2,85 3,6 3,95 4,2 4,59 4,97 5,65 6,27 6,57 998 999 2 2 22 23 24 25 26 27 year ourtesy of Čižman M.

University Medical entre Ljubljana cca. admissions/year Published guidelines: 998, 26 List of restricted antimicrobials: 999 In most cases pre-authorisation of restricted T mandatory by ID onsultations on the wards, rounds, telephone consultations Education, education, education

ID Guided TM Therapy: an Observational Study : restricted antimicrobials approved by ID : restricted antimicrobials approved by the head of the department : all antimicrobials prescribed by ID onsumption of ntibiotics: DDD T 25 Statistics: SPSS 5. (correlate : bivariate) eović, Čižman M, Seme K, Kreft S. J hemother (accepted for publication in February 29)

Relative hange in ntimicrobial onsumption (DDD/ patient-days),2,8,6,4,2 P=.6 998 999 2 2 22 23 24 25

Relative hange in ntimicrobial onsumption (DDD/ patient-days),2,8,6 NS NS,4,2 P=.6 998 999 2 2 22 23 24 25

2,8,6,4,2,8,6,4,2 Relative hange in ntimicrobial onsumption (DDD/ patients) P=.2 998 999 2 2 22 23 24 25

2,8,6,4,2,8,6,4,2 Relative hange in ntimicrobial onsumption (DDD/ patients) P=.2 P=.2 998 999 2 2 22 23 24 25 NS P=.6

Relative hange in ntimicrobial ost (Eur),8,6,4,2,8,6,4,2 p=.26 94 537 Eur 998 999 2 2 22 23 24 25

Relative hange in ntimicrobial ost (Eur),8,6,4,2,8,6,4,2 998 999 2 2 22 23 24 25

Relative hange in ntimicrobial ost (Eur),8,6,4,2,8,6,4,2 NS p=.6 53 94 Eur p=.26 94 537 Eur 998 999 2 2 22 23 24 25

In-hospital Mortality in % 4 3,5 3 2,5 2,5,5 998 999 2 2 22 23 24 25 all trends non-significant

P. aeruginosa : % susceptible to ciprofloxacin 3 2,5 2,5,5 NS 998 999 2 2 22 23 24 25

P. aeruginosa : % susceptible to ciprofloxacin 3 2,5 2,5,5 998 999 2 2 22 23 24 25

P. aeruginosa : % susceptible to ciprofloxacin 3 2,5 2,5 p=.8 p=.4,5 NS 998 999 2 2 22 23 24 25

Klebsiella spp. : susceptibility to 3 rd gen. cephalosporins 2,8,6,4,2,8,6,4,2 998 999 2 2 22 23 24 25

Klebsiella spp. : susceptibility to 3 rd gen. cephalosporins 2,8,6,4,2,8,6,4,2 p=.2 NS NS 998 999 2 2 22 23 24 25

S. aureus : susceptibility to methicillin 2,8,6,4,2,8,6,4,2 998 999 2 2 22 23 24 25

S. aureus : susceptibility to methicillin 2,8,6,4,2,8,6,4,2 p=. p=.4 p=.4 998 999 2 2 22 23 24 25

Length-of-stay 2,8,6,4,2,8,6,4,2 998 999 2 2 22 23 24 25

Length-of-stay 2,8,6,4,2,8,6,4,2 NS p=.3 p=.2 998 999 2 2 22 23 24 25 eović, Čižman M, Seme K, Kreft S. Unpublished

The Role of ID in ntibiotic Stewardship (Davey P, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients, ochrane Review 27) ID pre-authorisation Studies showing an effect in lowering consumption/cost Studies showing no effect YES 9 NO 5 3

to summarize... ID guided total T use may Decrease consumption Decrease cost Decrease LOS Decrease resistance in some bacteria No impact on mortality UT...

OUNIL OF THE EUROPEN UNION OUNIL ONLUSIONS ON NTIMIROIL RESISTNE 2876th Employment, Social Policy, Health and onsumers ffairs ouncil Meezing, Luxembourg, th June 28 2. LLS UPON THE MEMER STTES to -develop and implement strategies -establish intersectoral mechanisms -strengthen surveillance systems and improve data quality on MR and use of antimicrobial agents from both human health and veterinarian sector, and HI -further promote prudent use of antimicrobials -promote development and use of guidelines for best practices.

st st European ntimicrobial Resistance Day 8 th November 28

Does low prescribing mean improvement?