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National antibiotic program in the Czech Republic NAP-CZ

National antibiotic program in the Czech Republic NAP-CZ. Vlastimil Jindrák and Subcommitte for antibiotic policy ČLS JEP. Milestones of N AP-CZ …. 1970 – 75 Establishing Antibiotic Centres 1990 Establishing Working Group for AMR surveillance

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National antibiotic program in the Czech Republic NAP-CZ

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  1. National antibiotic program in the Czech RepublicNAP-CZ Vlastimil Jindrák and Subcommitte for antibiotic policy ČLS JEP

  2. Milestones of NAP-CZ… • 1970 – 75 Establishing Antibiotic Centres • 1990 Establishing Working Group for AMR surveillance • 1997 Subcommittee for antibiotic policy (co-ordinating group) • 2001 – 02 Preparatory working group for NAP-CZ in MoH • 2003 Basic document ofNAP-CZ, Committee in MoH • 2003 – 04 Quality projectsfocused on AMR • 2005 WHO country visit: recommendations to MoH • 2005 NAP Action plan – 2005 • 2006 NAP Action plan – 2006-07, WHO-ECDC co-operation • 2006 Committee in MoH cancelled • 2007 Negotiations SKAP – MoH: New model of NAP • 2008MoH decision: New model of NAP • 2008 AMR: priority for future EU Presidency of CZ EU Conference - Brdo - Slovenia

  3. Subcommittee for Antibiotic Policy (SKAP)structure of the Czech Medical Association J.E.Purkyně SKAPstructure interdisciplinary and intersectoral principle, confirmation of membership by professional societies SKAPactivitiesopponency and guarantee by professional societies, acceptation by presidium ČLS JEP guidelines – ATB consensus microbiology, epidemiology pharmacology, pharmacy guidelines – therapy, prophylaxis infectious diseases guidelines – AMR control SKAP paediatrics AP organization, ATB centers general practice action plans, interventions intern. med. (chemotherapy) internat. co-operation, projects veterinary medicine co-operation with veterinarians EU Conference - Brdo - Slovenia

  4. Intersectoral Coordination Mechanism Local level National level National Institute of Public Health Antibiotic centres Working groups Ministry of Health National Antibiotic Programme co-ordinating group Subcommitte on ATB Policy Czech Medical Association Professional Societies Veterinary antibiotic centres State Veterinary Administration Ministry of Agriculture EU Conference - Brdo - Slovenia

  5. Antibiotic centersbasic operating units of NAP-CZ EU Conference - Brdo - Slovenia

  6. Activities of antibiotic centers • Local surveillance of AMR in hospitals and community • Local surveillance of ATB use in hospitals and community • Consulting antibiotic use • Improving quality of antibiotic use – local interventions • Categorisation of antibiotics (restricted drugs) • Preparation and updating local guidelines • Education EU Conference - Brdo - Slovenia

  7. Antibiotic consumption in the Czech Republictrends in ambulatory consumption 1989 - 2000 14 DDD/1000/day (1989) 19DDD/1000/day (1999) EU Conference - Brdo - Slovenia

  8. Intervention in primary paediatric care (ATB consumption – ESAC)repeated, multicentric ATB prescribing audit 1998-02 intervention in primary paediatric care - 2001 EU Conference - Brdo - Slovenia

  9. Resistance S.pneumoniae in Europe - EARSS-2005penicillin EU Conference - Brdo - Slovenia

  10. Resistance S.pyogenes to erythromycine in CZtrend 1996 – 2005, data NRL for antibiotics intervention in primary paediatric care - 2001 EU Conference - Brdo - Slovenia

  11. Invasive MRSA in CZ hospitals trend in 2000 – 2005 (EARSS data) 4.3 % 5.9 % 5.9 % 6.1 % 8.5 % 12.9 % EU Conference - Brdo - Slovenia

  12. Klebsiella pneumoniae – EARSS 2005resistance to 3rd generation cephalosporins EU Conference - Brdo - Slovenia

  13. AMR problems in CZ hospitalsPotential reasons for increasing trend • Lack of systematic interventions for improving ATB use (auditing, feed-back for prescribers and consultants…) • Sub-optimal hospital infection control programmes (lack of capacities for isolation, missing infection control nurses…) • Performance-oriented hospital care, de-motivating economic feed-back, sub-optimal organisation of intensive care • Influence of pharmaceutical industry • Need for innovation of local ATB stewardship programmes • Need for improvement of local infection control programmes EU Conference - Brdo - Slovenia

  14. National antibiotic program – Czech experienceConditions for future developments, benefits and efficiency • Wide activities realised on the voluntary basis are not sustainable in long-term perspective and decline efficiency • Support of government is essential for successful NAP activities at the national level • The role of government consists in creating sufficient conditions for complex professional activities (realizing action plans), not in direct management of NAP by state • Organizational structures of low vulnerability by political changes are necessary for long lasting stability, continuity and efficiency of NAP EU Conference - Brdo - Slovenia

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