Скачать презентацию The Swedish Experience Otto Cars Prof Infectious Diseases Скачать презентацию The Swedish Experience Otto Cars Prof Infectious Diseases

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The Swedish Experience Otto Cars Prof. Infectious Diseases Uppsala University Hospital Sweden The Swedish Experience Otto Cars Prof. Infectious Diseases Uppsala University Hospital Sweden

The Global Challenge Antibiotics are losing their effect at a pace that was unforeseen The Global Challenge Antibiotics are losing their effect at a pace that was unforeseen just five years ago The pipeline of new drugs is empty

ESBL (CTX-M) producing Enterobacteriaceae ESBL (CTX-M) producing Enterobacteriaceae

The consequences……. Bloodstream infection: 43. 5% of the children with Gramnegative bloodstream infection died The consequences……. Bloodstream infection: 43. 5% of the children with Gramnegative bloodstream infection died in a Tanzanian study (Blomberg, 2007). ESBL & MDR Gram-negatives: In Israel 3% of all fatalities in hospitals related to Gram-negative multiresistant nosocomial infections (Carmeli, 2006). www. reactgroup. org

Clonal outbreak of av multiresistant Klebsiella pneumoniae Uppsala University Hospital Clonal outbreak of av multiresistant Klebsiella pneumoniae Uppsala University Hospital

The Current Paradox: Antibiotic Resistance Drug Development Morbidity Mortality Costs The Current Paradox: Antibiotic Resistance Drug Development Morbidity Mortality Costs

Hip replacement Transplants Cancer chemotherapy Infections in preterm babies Hip replacement Transplants Cancer chemotherapy Infections in preterm babies

The Swedish Experience The Swedish Strategic Programme Against Antibiotic Resistance Overall objective To preserve The Swedish Experience The Swedish Strategic Programme Against Antibiotic Resistance Overall objective To preserve effective antibacterial therapy for the future http: // www. strama. se

NATIONAL LEVEL National co-ordinating group Surveillance National projects LOCAL LEVEL Local co-ordinating groups NATIONAL LEVEL National co-ordinating group Surveillance National projects LOCAL LEVEL Local co-ordinating groups Implementation Behavioural change

Projects and interventions initiated in many areas Primary care Intensive care Hospital care Nursing Projects and interventions initiated in many areas Primary care Intensive care Hospital care Nursing homes Day care centres School children

NATIONAL LEVEL National co-ordinating group Surveillance National projects LOCAL LEVEL Local co-ordinating groups NATIONAL LEVEL National co-ordinating group Surveillance National projects LOCAL LEVEL Local co-ordinating groups Implementation Behavioural change

• Strama-groups were formed in every county. • The County Medical Officers for • Strama-groups were formed in every county. • The County Medical Officers for Communicable have a leading role in these groups which include specialists from different medical fields • The main objective is to evaluate the use antibiotics and antibacterial resistance in the region and to improve prescribing patterns

Strama-some examples of activities • Local implementation of guidelines • Sales statistics, Resistance data Strama-some examples of activities • Local implementation of guidelines • Sales statistics, Resistance data • Feedback and audit • Newsletter, website, • Fund for local projects • Educational activities “ Strama workshops”

DDD/1000ính/day Effect of prescriber feedback on consumption of fluoroquinolones in four primary care districts DDD/1000ính/day Effect of prescriber feedback on consumption of fluoroquinolones in four primary care districts of Uppsala County

DDD/1000ính/day Effect of prescriber feedback on consumption of fluoroquinolones in four primary care districts DDD/1000ính/day Effect of prescriber feedback on consumption of fluoroquinolones in four primary care districts of Uppsala County

Awareness raising of all stakeholders through news media Patient Authorities Prescriber MEDIA Awareness raising of all stakeholders through news media Patient Authorities Prescriber MEDIA

Prescriptions of antibiotics for UTI (outpatients) Fluoroquinolones ”Små cipro” avser ciprofloxacin 100 mg 6 Prescriptions of antibiotics for UTI (outpatients) Fluoroquinolones ”Små cipro” avser ciprofloxacin 100 mg 6 resp 10 tabl, 250 mg 10 tabl och 500 mg 10 tabl.

DDD/1000 inhabitants/day Total sales of Antibiotics in the Nordic Countries 1978 -2006* . *Excluding DDD/1000 inhabitants/day Total sales of Antibiotics in the Nordic Countries 1978 -2006* . *Excluding Metenamine. Before 1998 figures from Denmark do not include hospital use

Possible success factors Multidisciplinary coordinating group- involving all stakeholders Governmental support and mandate Possible success factors Multidisciplinary coordinating group- involving all stakeholders Governmental support and mandate Decentralised organisation and local ownership Credible, scientifically based messages and actions Clear communication and media strategy

Conclusions It is possible to achieve a significant change in antibiotic use at the Conclusions It is possible to achieve a significant change in antibiotic use at the national level. To be sustainable, political/financial support is needed. Despite low antibiotic consumption resistance rates are incrasing

Re. Action on Antibiotic Resistance www. reactgroup. org Re. Action on Antibiotic Resistance www. reactgroup. org