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Recommendation on prudent use of antimicrobial agents in human medicine – Slovenian experiences

Recommendation on prudent use of antimicrobial agents in human medicine – Slovenian experiences. Intersectoral Coordination Mechanism Prof. Milan Čižman, MD, Head. Implementation of the Council recommendation 2002/77/EC on the prudent use of antimicrobial agents in human medicine in Slovenia.

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Recommendation on prudent use of antimicrobial agents in human medicine – Slovenian experiences

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  1. Recommendation on prudent use of antimicrobial agents in human medicine – Slovenian experiences Intersectoral Coordination Mechanism Prof. Milan Čižman, MD, Head

  2. Implementation of the Council recommendation 2002/77/EC on the prudent use of antimicrobial agents in human medicine in Slovenia • Intersectoral coordination mechanism established in 2005 • National strategy prepared in 2006 • National action plan formulated in 2006

  3. Agenda • MRSA prevalence in Slovenia 2000-2006 • 21.4%to 7.1% - reduction of 67% • Outpatient antibiotic use in Slovenia 2000 – 2007 • 20.1 to 16.0 DDD/1000 inhab./day – reduction 20.3% • Increase of VRE prevalence  2005-2006 • <1 to 6% • Recommendations • MRSA • antibiotic consumption in outpatients www.rivm.ne/earss

  4. Resistance levels (%) for invasive strains of S. aureus to methicillin (MRSA) in Slovenia and at University Medical centre (UMC), Ljubljana, Slovenia

  5. MRSA in Slovenia /1 • PPS of hospital acquired infections (HAI) in Slovenian adult ICU, April 1997 – 6/8 (75% of adult ICUs) • PPS of HAI in Slovenian adults ICU, October 2001 – 5/8 (60 % of adult ICUs) • National PPS of HAI in acute care hospitals, October 2001 - 21/34 (62% of acute care hospitals) Muzlovic I, et al. IDSA 2001. Klaus I, et al. J Hosp Infect 2003, 54: 149.

  6. MRSA in Slovenia /2 • Comprehensive infection control program: MRSA cases acquired in hospitals decreased from 50% to 6.1% (1999-2002) • Infection control measures: incidence of ICU – acquired MRSA decreased from 7.8 to 1.9 %. • Legislation and regulation of infection control program in health care institutions (1999)* • Audit of infection control implementations in health cares institutions (2006)** Tomič V, et al. Arch Intern Med 2004, 164:2038 Trampuž A. ICAAC 2001 K-1219 *Official Journal of the R Slovenia. Uradni list RS. št. 74- 3597/1999 **Official Journal of the R Slovenia. Uradni list RS. št. 92/2006

  7. Strategy for MRSA in Slovenia /1 • Active Surveillance Culture • Selective screening for MRSA in all patients at risk for carriage on admission. • Barrier precautions for patients • Contact isolation for patient with MRSA • Promotion of hand hygiene • Use of alcohol–based hand rub • Selective decolonization – eradication of MRSA carriage

  8. Strategy for MRSA in Slovenia /2 • Improved communication (reporting) about patients with MRSA (MDROs) within and between health care facilities. • Continuous education of HCW on appropriate hygiene procedures (hospitals, nursing homes). • Use of hospital computer system to record MRSA carriers.

  9. Strategy for MRSA in Slovenia /3Education • Professionals • Postgraduate educational courses are organized by Medical Faculty Ljubljana since 1984 (162 physicians and 290 nurses). • National scientific meetings • Patients • Newspapers, magazines, TV, leaflets • Spread of informations to media and politicians.

  10. Outpatient antibiotic use in Slovenia 1997-2007

  11. Analysis of decreased outpatient antibiotic consumption in Slovenia • The consumption decreased more for restricted than for non-restricted antibiotics: 27.7% vs 16.1% decrease (1999-2007) • Positive correlation between antibiotic consumption and repeated media reports • Negative correlation between antibiotic consumption and the number of rapid diagnostic tests (CRP, Streptococcal antigen tests)

  12. Antibiotic prescriptions (J01) in children (0-14 years) and adults ( 15 years) and %penicillin-non-susceptible (I+R) S. pneumoniae, 2002-2006

  13. CONCLUSION • Compliance to infection control guidelines for MRSA control • Nation-wide awareness: HCW, lay public, politicians • Enough single rooms, and staff • To control antibiotic consumption in outpatients the combinations of restrictive and education measures are recommended • Prudent use of rapid diagnostic tests may decrease the antimicrobial consumption in outpatients • Higher antibiotic consumption and resistance rates in certain bacteria are observed in children

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