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Iskustvo upravljanja antimikrobnim lijekovima u KC Ljubljana

Iskustvo upravljanja antimikrobnim lijekovima u KC Ljubljana. prof. dr. Bojana Beović, dr.med. UMC Ljubljana. https://www.kclj.si/index.php?dir=/ukc_ljubljana/o_nas/osebna_izkaznica_ukcl. Structure : Organisation of antimicrobial stewardship in UMC Ljubljana.

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Iskustvo upravljanja antimikrobnim lijekovima u KC Ljubljana

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  1. Iskustvoupravljanjaantimikrobnimlijekovima u KC Ljubljana prof. dr. Bojana Beović, dr.med.

  2. UMC Ljubljana https://www.kclj.si/index.php?dir=/ukc_ljubljana/o_nas/osebna_izkaznica_ukcl

  3. Structure: Organisationofantimicrobialstewardship in UMC Ljubljana Medicaldirector, MedicalCouncil AntibioticCommittee Department • Department • Department • Department DepartmentofInfectiousDiseases, Theconsultancyunit • Department • Department • Department Pharmacy MicrobiologyLaboratory (outside)

  4. Theuseofantibacterial (J01) 1998 to 2017 in DDD/100 patient-days

  5. Theuseofantibacterial (J01) 1998 to 2017 in DDD/100 admissions

  6. Resistanceratesofbacteriaisolated from sterilespecimens 1998 – 2017: Gram-positiveisolates Beović B, etal. Infektološki simpozij 2018

  7. Resistanceratesofbacteriaisolated from sterilespecimens 1998 – 2017: Gram-negative isolates Beović B, etal. Infektološki simpozij 2018

  8. UMC Ljubljana

  9. UMC Ljubljana: restrictiveinterventions

  10. List ofrestrictedantimicrobials 1999 Criteria • last line antibiotics • toxicity • cost Procedure • approvalbyan ID physicianneeded • form fortheapproval • ICUs: approvalbytheheadoftheunit or ID • hematology: approvalbytheheadoftheunit

  11. Restrictiveinterventions: antibiotics

  12. Do restrictionswork?

  13. Use ofantibiotics (J01) 1998 to 2017 (DDD/100 patient-days) UKC: totaluse, R: restrictedantimicrobials

  14. 2010 Restrictionof 2nd, 3rd, and 4thgenerationcephalosporins 1stgenerationcouldbe used forsurgicalprophylaxis Thedecreaseofuseofallcephalosporins, 2nd and 3rd generationwasstatisticallysignificant.

  15. Resistanceratesofbacteriaisolated from sterilespecimens 1998 – 2017: Gram-negative isolates Beović B, etal. Infektološki simpozij 2018

  16. WhichIntervention to Choose? A recentcomparison in a crossoverstudyshowed: • Improvedadherence to guidelines in prospectiveaudit/feedbackon day 3 • Lowerantibioticuse in prospectiveaudit/feedback Preprescription Authorisation: the prescriber seeks input from an expert (AMS team) before prescribing an antibiotic. vs Prospective audit (postprescriptional review) and feedback: prescriber decides on antimicrobial therapy himself, the AMS team intervenes after48 to 72 hours: adjustment, discontinuation… Tamma PD, etal. Clin Infect Dis 2017;64(5):537–43

  17. „Campaigns“

  18. Duration of antimicrobial treatment

  19. Use ofantibiotics (J01) 1998 to 2017 (DDD/100 patient-days) UKC: totaluse, R: restrictedantimicrobials

  20. „Antibioticrounds“

  21. Totalcontrolofantibioticuse:RelativeChange in AntimicrobialConsumptionA: restrictedantimicrobialapprovedby IDB: restrictedantimicrobialsapprovedbytheheadoftheunitC:: totalcontrolofantibioticuseby ID NS NS P=0.006 Beović B, etal. J Chemother 2009.

  22. Relative Change in Antimicrobial Cost (Eur) NS p=0.016 153 941 Eur p=0.026 94 537 Eur Beović B, etal. J Chemother 2009.

  23. Monthlycostofantibiotics at theDivisionofTraumatology (Eur) Antibioticrounds Monthlymean 2012-2015 MonthlymeanOct 2016 to May 2018

  24. UMC Ljubljana: theguidelines

  25. Guidelines: local and national www.quibaguide.com

  26. Antimicrobialprophylaxis in surgery

  27. Durationofantimicrobialprophylaxis in UMC Ljubljana Rožič M, etal. Infektološki simpozij 2016, ECDC PPS 2017, unpublished

  28. RecommendedStaffingfor AMS Programmes in Hospitals Pulcini C, etal. ClinMicrobiol Infect 2017;23:785e787

  29. AMS in UMC Ljubljana: thewayforward

  30. Antimicrobialusestrategy in UMC Ljubljana 2019-24 • 1 FTE per 500 hospitalbeds, inclusionofclinicalpharmacist • Prospectiveaudit and feed-back in some departments (ICU) • Introductionofantibioticrounds in more departments • Localguidelinesforcommonsyndromes (simple, clearmessages) • Antibioticsurgicalguidelines • Therapeutic drug monitoring (informatisation) • Computerisedprescribingofantibiotics • Guidelinesforrapidmicrobiologydiagnostics • Mandatory on-line courses in antimicrobialprescribingforyoungdoctors in training ApprovedbyMedicalCouncil UMC Ljubljana, October 2018

  31. Thankyou!

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