CPMU Research Evening Symposium Benchmarking Antimicrobial Use Paul Wade Consultant Pharmacist Infectious Diseases Guy s & St. Thomas NHS Foundation Trust 14th March 2013
Disclosures Honoraria, consultancy fees & speakers bureau fees from: Astellas AstraZeneca Cubist Gilead ICNet Merck Novartis Pfizer Wyeth
Antibiotics: from the cradle to the grave?
Timeline for deployment & resistance
European resistance data - Fluoroquinolone (R) E. coli http://ecdc.europa.eu/en/activities/surveillance/ears-net/database/pages/map_reports.aspx 2005 2011
European resistance data - Carbapenem (R) K. pneumoniae http://ecdc.europa.eu/en/activities/surveillance/ears-net/database/pages/map_reports.aspx 2005 2011
European resistance data - MDR-K. pneumoniae http://ecdc.europa.eu/en/activities/surveillance/ears-net/database/pages/map_reports.aspx 2005 2011 Resistant to: 3G-cephalosporins, fluoroquinolones, aminoglycosides
What s the real problem in the UK?
Closer to home http://www.hpa.org.uk/web/hpawebfile/hpaweb_c/1294740725984
New antibacterials: 1998-2004
? O ü O O Actual data Assumed from MOA? ü ü O? ü ECDC 2009
Back to the future?
Pharma / societal drivers Shareholder dividends Pharma is a business Reconfigurations within Pharma Net present value estimated likely costs vs estimated likely profits antimicrobials have low net present value compared to statins, ACE inhibitors, monoclonals, etc. How much are antibiotics worth?
What s next? Tremendous press coverage in November 2011 Early Day Motion in House of Commons All-Party Parliamentary Group Petition please sign www.antibiotic-action.com
Data, data, data
What about local data? Antibacterial Consumption: London Acute Teaching Trusts - April 2011-March 2012 Cef uroxime Ciprof loxacin Clarithromycin Clindamycin Trust Attributable CDI 350 160 300 140 250 120 DDDs Per 1000 Bed Days 200 150 100 80 60 CDI Cases 100 40 50 20 0 1 2 3 4 5 6 7 8 9 10 Trust Number 0
LATTICe Group Antibacterial Consumption: London Acute Teaching Trusts - April 2011-March 2012 Amoxicillin Cef alexin Co-amoxiclav Flucloxacillin Trust Attributable CDI 900 160 800 140 700 120 DDDs Per 1000 Bed Days 600 500 400 300 100 80 60 CDI Cases 200 40 100 20 0 1 2 3 4 5 6 7 8 9 10 Trust Number 0
LATTICe Group Antibacterial Consumption: London Acute Teaching Trusts - April 2011-March 2012 Amikacin Cef tazidime Colistin Meropenem Piperacillin/Tazobactam Trust Attributable CDI 100 160 90 140 80 DDDs Per 1000 Bed Days 70 60 50 40 30 20 120 100 80 60 40 CDI Cases 10 20 0 1 2 3 4 5 6 7 8 9 10 Trust Number 0
What about *really* local data? GSTT Antibacterial Consumption 2011-2013 Cef uroxime Ciprof loxacin Clarithromycin Clindamycin Trust Attributable CDI 160 50 DDDs Per 1000 Bed Days 140 120 100 80 60 40 20 45 40 35 30 25 20 15 10 5 CDI Cases 0 Q1 2011-12 Q2 2011-12 Q3 2011-12 Q4 2011-12 Q1 2012-13 Q2 2012-13 Q3 2012-13 Time Period 0
GSTT GSTT Antibacterial Consumption 2011-13 Amoxicillin Cef alexin Co-amoxiclav Flucloxacillin Trust Attributable CDI 800 50 DDDs Per 1000 Bed Days 700 600 500 400 300 200 100 45 40 35 30 25 20 15 10 5 CDI Cases 0 Q1 2011-12 Q2 2011-12 Q3 2011-12 Q4 2011-12 Q1 2012-13 Q2 2012-13 Q3 2012-13 Time Period 0
GSTT GSTT Antibacterial Consumption 2011-13 Amikacin Cef tazidime Colistin IV Meropenem Piperacillin/Tazobactam Trust Attributable CDI 35 50 30 45 40 DDDs Per 1000 Bed Days 25 20 15 10 35 30 25 20 15 CDI Cases 5 10 5 0 Q1 2011-12 Q2 2011-12 Q3 2011-12 Q4 2011-12 Q1 2012-13 Q2 2012-13 Q3 2012-13 Time Period 0
Drilling down even further GSTT Antibacterial Consumption 2010-2012: High Risk Agents Acute Medicine Directorate Amoxicillin C efuroxime C iprofloxacin C larithromycin C lindamycin C o- amoxiclav 9000 8000 7000 6000 5000 DDDs 4000 3000 2000 1000 0 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Month
Or drilling for longer GSTT Critical Care Antibacterial Consumption: Gentamicin & Piperacillin/Tazobactam 2006-2012 250 200 DDDs Per 1000 Bed Days 150 100 50 0 April 2006 July 2006 October 2006 January 2007 April 2007 July 2007 October 2007 January 2008 April 2008 July 2008 October 2008 January 2009 April 2009 July 2009 October 2009 January 2010 April 2010 July 2010 October 2010 January 2011 April 2011 July 2011 October 2011 January 2012 April 2012 July 2012 October 2012 Month
Simplifying the process Newly available Purchased by NHS London for all Trusts in SHA Allows direct comparison of Trust drug usage Will calculate DDDs automatically Needs some work to determine validity across Trusts Then needs some work to explain variance
Sample data available The generation of data is the easy part Can be done in seconds Very flexible/user-definable Doesn t yet have activity measures built in e.g. bed days, admissions, episodes Doesn t yet have outcome measures built in e.g. C. difficile rates, length of stay The interpretation is where the value lies
Final words from CMO report
Any questions? Email: paul.wade@gstt.nhs.uk