European Antibiotic Awareness Day 2009 What is the problem? Latest data on antibiotic resistance Zsuzsanna Jakab, ECDC Director Launch Seminar for EAAD Stockholm, 18 November 2009 Fluoroquinolone-resistant Escherichia coli in EU/EEA countries 2003 2008 Source: European Antimicrobial Resistance Surveillance System (EARSS), 2008
Methicillin-resistant Staphylococcus aureus (MRSA), blood and spinal fluid 2003 2008 Source: European Antimicrobial Resistance Surveillance System (EARSS), 2008 Relationship between antibiotic use and resistance in the community 60 Antibiotic resistance (%Macrolide-R S. pneumoniae from community-acquired RTIs, 1998) 40 20 0 R 2 =0.66 P<0.001 0 2 4 6 8 Antibiotic consumption (Outpatient consumption of macrolides and lincosamides, DDD per 1,000 inh-days, 1997) Each data point represents one country Source: Alexander Project; FINRES; STRAMA; DANMAP; Cars et al., 2001.
Antibiotic prescribing and consumption vary between European countries DDD per 1000 inhabitants and per day 40 35 30 25 20 15 10 Other J01 classes (J01B, J01G, J01R, J01X) Sulfonamides and trimethoprim (J01E) Quinolones (J01M) Macrolides, lincosamides and streptogramins (J01F) Tetracyclines (J01A) Cephalosporins and other beta-lactams (J01D) Penicillins (J01C) 5 0 Cyprus* Greece*,** France Italy Luxembourg Belgium Slovakia Ireland Portugal Bulgaria *Total use, i.e. including inpatients, for Cyprus, Estonia, Greece and Lithuania. **2006 data for Germany, Greece, Iceland and Lithuania; 2005 data for Poland and United Kingdom. ***Reimbursement data, which do not include over-the-counter sales without prescription. Iceland** Spain*** Poland** Finland Lithuania*,** Czech Republic Denmark Slovenia Estonia* Sweden Hungary United Kingdom** Norway Austria Germany** Latvia Netherlands Source: European Surveillance of Antimicrobial Consumption (ESAC), 2008 Modern medicine is not possible without effective antimicrobials Hip replacement Organ transplants Cancer chemotherapy Intensive care Care of preterm babies Photo by interplast (http://www.flickr.com/photos/interplast/115125072), reproduced under a Creative Commons license. Animated slide: please wait
Survey results on intensive-care patients infected with resistant bacteria Methicillin-resistant Staphylococcus aureus (MRSA) Grampositive bacteria Vancomycin-resistant Enterococcus spp. (VRE) Penicillin-resistant Streptococcus pneumoniae (PRSP) Vancomycin-resistant/intermediate S. aureus (VRSA/VISA) Gramnegative bacteria Third-generation cephalosporin-resistant Enterobacteriaceae Carbapenem-resistant Pseudomonas aeruginosa Carbapenem-resistant Acinetobacter spp. Carbapenem-resistant Enterobacteriaceae Bacteria totally or almost totally resistant to available antibiotics 0 20 40 60 80 100 % respondents >10 patients 3-10 patients 1-2 patients 0 Do not know Missing Source: Eurosurveillance, 12 Nov 2009. Alain Lepape, Dominique L. Monnet, on behalf of participating members of the European Society of Intensive Care Medicine (ESICM) How can we stop antibiotic resistance? Prudent use of antibiotics (only when needed, correct dose, dose intervals, duration). Infection control (hand hygiene, screening, isolation). Development of new antibiotics (focus of Swedish EU Presidency). www.se2009.eu
ECDC s Antimicrobial Resistance and Healthcare-Associated Infections Programme Pan-European surveillance of antibiotic resistance and antibiotic consumption (outsourced). Ad-hoc surveys and reports when surveillance does not exist. Risk assessments and guidance for the prevention and control of multidrug-resistant bacteria. Coordination of activities through a network of National AMR Focal Points (one per country). Country visits to discuss AMR issues on the basis of Council Recommendation 2002/77/EC (upon invitation from the country). Communication. European Antibiotic Awareness Day targeting prudent antibiotic use Targeting prudent antibiotic use in primary care. Message 'Cold? Flu? Take care, not antibiotics!' Materials targeting primary care prescribers. TV and Web spots
European Antibiotic Awareness Day multilingual website European Antibiotic Awareness Day: What is happening across Europe today Slovenia: TV spot; point-prevalence study on antibiotic consumption in children at primary level. France: Press release on actions organised in France; launch of French MoH antibiotic website with up-to-date treatment recommendations for clinicians; local and regional level events. Czech Republic: Round table meeting with stakeholder representatives to mark EAAD, organised with support of WHO office; special issue of Bulletin of Association of General Practitioners with distribution for free to 5000 GPs. Sweden: Joint launch seminar and press release with ECDC and Swedish EU Presidency; TV spots broadcast in cinema theatres; many STRAMA activities. Spain: Scientific conferences in Madrid and Barcelona; press conference by professional societies. Belgium: Launch of 9th national campaign, including TV spot, website, letter plus posters and leaflets to GPs and pharmacists; special issue of Huisarts Nu devoted to EAAD. Hungary: National scientific conference and press conference with participation of Minister for Health and Chief Medical Officer; TV spots on main and regional channels.
ECDC working closely with EU Presidencies ECDC is working closely in support of the EU Presidency countries to keep antibiotic resistance high on the EU agenda. Swedish EU Presidency ECDC-EMEA joint report on 'The bacterial challenge time to react' was published for the EU conference 'Innovative incentives for effective antibacterials' in Stockholm on 17 September. EU/US Joint Taskforce on AMR is being created following the last US-EU Summit in Washington (DC) on 3-4 November. In 2010, the US CDC will launch its 'Get smart' campaign on prudent use of antibiotics on 18 November. In 2010, European Antibiotic Awareness Day will focus on hospitals, and the EU Presidency countries will continue to prioritise AMR: Spain: patient safety and infection control. Belgium: healthcare acquired infections and antibiotic use. ECDC is already working with WHO Euro to promote the campaign beyond the EU borders. Thank you!