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
Disclosures
Outline Background Methods Results Targets and actions Conclusion
Global-PPS : an innovative worldwide accessible web-based tool designed by the University of Antwerp, Belgium (www.global-pps.com) 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
Participation to Global PPS according to UN macro geographical regions (2017)
G-PPS Habib Bourguiba Hospital (HBH), Sfax, Tunisia 450 beds
Evolution of third-generation cephalosporin resistance in Enterobacteriaceae in HB hospital % R 100 90 80 70 K. pneumoniae E. coli ESBL spread 60 50 40 36 42 42 45 42 47 50 47 45 44 40 49 46 45 47 50 52 30 20 10 22 4 28 2 4 3 6 7 7 9 7 7 9 9 9 12 15 19 22 24 26 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Evolution of carbapenem resistance in Enterobacteriaceae in HB hospital 60 % R 50 % imipenem resistance K. pneumoniae Carbapenemase spread 40 30 SPREAD of NDM 20 15 15 20 23 23 10 0 10 6 2,2 0 0 0 0 0 0 0 0 0 0 0,5 0,1 0 0,6 1,5 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Evolution of carbapenem resistance in non fermenter Gram-negative bacilli in HB hospital 100 % R 90 A. baumannii 86 88 87 88 80 P. aeruginosa 71 76 72 81 70 60 50 50,2 56 53,5 51 50 51 40 37,7 30 20 10 18,3 18,9 6,8 4,5 20,5 24,2 17,5 22,1 24,3 13,1 17,5 18 17,4 7 24,5 23,3 36,5 23 23 25 28 26 23 32,3 24 27 21 20 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Années
Poor hygiene Antibiotic misuse 10
Methods Global-PPS was carried out in Habib Bourguiba university hospital in Tunisia between November and December 2017 Protocol (www.global-pps.com) 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
Antibiotic prevalence rates 127 among 320 hospitalized patients
Type of indication 1% 18% 36% CAI HAI Prophylaxis unknown 45%
Overall proportional antibiotic use (2017) other beta-lactams
Proportional use of other beta lactam antibacterials (2017)
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 1 4 4 5 4 8 10 10 13 21 22 24 36 39 0 5 10 15 20 25 30 35 40 45
Frequently used antibiotics for sepsis
Frequently used antibiotics for pneumonia
Frequently used antibiotics for surgical prophylaxis
Duration of surgical prophylaxis
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)
Quality indicators of antibiotic use
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
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
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
Actions : Result interpretation reports sent to all participating wards (feedback) Team : a representative person from each ward, infectious disease specialists, microbiologists and pharmacists
Actions: Develop local guidelines Surgical prophylaxis Common HAI (sepsis, pneumonia, UTI) Education and practice changes
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
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