抗生素的慎重使用（英文ppt）european antibiotics awarness day课件

InsertNameofpresenter InsertNameofhospital Usingantibioticsprudently HospitalPrescriberPresentation Contentsofthispresentation Antibioticresistance apatientsafetyissueSituationinIrelandDriversofantibioticresistanceConsequencesofantibioticresistanceWhyinappropriateuseofantibioticscontributestoantibioticresistance the why Howprudentuseofantibioticscanbepromotedinhospitals the how EuropeanAntibioticAwarenessDay acampaigntopromoteprudentuseofantibiotics 2 Antibioticresistance apatientsafetyissue 3 Antibioticresistance aprobleminthepresentandthefuture Antibioticresistanceisanincreasinglyseriouspublichealthproblem resistantbacteriahavebecomeaneverydayconcerninIrishhospitals 4 Trendsinantibioticresistance invasiveinfections inIreland 2002 2009 Source EuropeanAntimicrobialResistanceSurveillanceSystem EARSS andHealthProtectionSurveillanceCentre HPSC 20022007 Meticillin resistantStaphylococcusaureus MRSA bloodstreaminfectionsinEurope Source EuropeanAntimicrobialResistanceSurveillanceSystem EARSS 2008 5 S aureus MRSAbacteraemiatrendsbyquarter 2002 2010Q2 Datafor2010provisionaluptotheendofQ2 Numberoflaboratoriesparticipatingbyyear endindicatedabovetheQ4bars MRSAinEurope 2007 oftenhigh butdecreasinginmanycountries Countrywithasignificantincrease 2005 2007 Countrywithasignificantdecrease 2005 2007 MRSA Source EARSS ECDC 2009 No ofcountries 7 Ireland Antimicrobialresistanceingram negativebacteria EU 2007 alreadyhighorincreasing Countrywithasignificantincrease 2005 2007 Countrywithasignificantdecrease 2005 2007 Carbapenem resistantPseudomonasaeruginosa 3rd gen ceph resistantKlebsiellapneumoniae 3rd gen ceph resistantEscherichiacoli Source EARSS ECDC 2009 No ofcountries No ofcountries 8 Source EuropeanSurveillanceofAntimicrobialConsumption ESAC 2010 In ECDCAnnualEpidemiologicalReport2010 inpress TotaloutpatientantibioticuseinEUMemberStates IcelandandNorway 2008 9 Totaluse i e includinginpatients CY GR LT Reimbursementdata i e notincludingover the countersaleswithoutaprescription ES Datafrom2007 MT AntibioticconsumptioninacutehospitalsinIreland 2007toQ22010 Datasource HPSC FluoroquinoloneconsumptioninacutehospitalsinIreland 2007toQ22010 11 Datasource HPSC Hospitalantibioticprevalencesurvey 2009 prevalenceofantibioticuse Hospitalantibioticprevalencesurvey 2009 indicationsforantibioticuse 13 Hospitalantibioticprevalencesurvey 2009 durationofperi operativeprophylaxis 14 Antibioticuseat inserthospitalname Insertindividualhospitalantibioticconsumptiondata availablefromhospitalpharmacistorfromAjayOzaatHPSC Antibioticresistance Apatientsafetyissueforallhospitals Theemergence selectionandspreadofresistantbacteriainhospitalsisamajorpatientsafetyissue Infectionswithantibiotic resistantbacteriacanresultinincreasedpatientmorbidityandmortality aswellasincreasedhospitallengthofstay 1 2Antibioticresistancefrequentlyleadstoadelayinappropriateantibiotictherapy 3Inappropriateordelayedantibiotictherapyinpatientswithsevereinfectionsisassociatedwithworsepatientoutcomesandsometimesdeath 4 6 16 1 CosgroveSE CarmeliY Theimpactofantimicrobialresistanceonhealthandeconomicoutcomes ClinInfectDis 2003Jun1 36 11 1433 7 2 RobertsRR HotaB AhmadI ScottRD 2nd FosterSD AbbasiF etal Hospitalandsocietalcostsofantimicrobial resistantinfectionsinaChicagoteachinghospital implicationsforantibioticstewardship ClinInfectDis 2009Oct15 49 8 1175 84 3 KollefMH ShermanG WardS FraserVJ Inadequateantimicrobialtreatmentofinfections ariskfactorforhospitalmortalityamongcriticallyillpatients Chest 1999Feb 115 2 462 74 4 IbrahimEH ShermanG WardS FraserVJ KollefMH TheinfluenceofinadequateantimicrobialtreatmentofbloodstreaminfectionsonpatientoutcomesintheICUsetting Chest 2000Jul 118 1 146 55 5 LodiseTP McKinnonPS SwiderskiL RybakMJ Outcomesanalysisofdelayedantibiotictreatmentforhospital acquiredStaphylococcusaureusbacteremia ClinInfectDis 2003Jun1 36 11 1418 23 6 Alvarez LermaF Modificationofempiricantibiotictreatmentinpatientswithpneumoniaacquiredintheintensivecareunit ICU AcquiredneumoniaStudyGroup IntensiveCareMed 1996May 22 5 387 94 Antibioticresistance adailyoccurrenceinourhospital Inour country hospital themostfrequentresistantinfectionsarethefollowing insertappropriatedatawhereavailable Theseinfectionshaveresultedin insertdataonadditionaldaysofhospitalisation morbidity mortality andcostswhereavailable 17 Whyinappropriateuseofantibioticscontributestoantibioticresistance the why 18 In patientsareathighriskofantibiotic resistantinfections Misuseofantibioticsinhospitalsisoneofthemainfactorsthatdrivedevelopmentofantibioticresistance 7 9Patientsinhospitalshaveahighprobabilityofreceivinganantibiotic10and50 ofallantibioticuseinhospitalscanbeinappropriate 11 12Ina2009prevalencesurveyofantibioticuseinIrishhospitals 34 ofpatientswerereceivingantibioticsonthedayofthesurvey42 ofantibioticusedidnotfollowevidence basedguidelines 19 7 SinghN YuVL RationalempiricantibioticprescriptionintheICU Chest 2000May 117 5 1496 9 8 LeschCA ItokazuGS DanzigerLH WeinsteinRA Multi hospitalanalysisofantimicrobialusageandresistancetrends DiagnMicrobiolInfectDis 2001Nov 41 3 149 54 9 LepperPM GrusaE ReichlH HogelJ TrautmannM Consumptionofimipenemcorrelateswithbeta lactamresistanceinPseudomonasaeruginosa AntimicrobAgentsChemother 2002Sep 46 9 2920 5 10 AnsariF ErntellM GoossensH DaveyP TheEuropeansurveillanceofantimicrobialconsumption ESAC point prevalencesurveyofantibacterialusein20Europeanhospitalsin2006 ClinInfectDis 2009Nov15 49 10 1496 504 11 DaveyP BrownE FenelonL FinchR GouldI HartmanG etal Interventionstoimproveantibioticprescribingpracticesforhospitalinpatients CochraneDatabaseSystRev 2005 4 CD003543 12 WillemsenI GroenhuijzenA BogaersD StuurmanA vanKeulenP KluytmansJ Appropriatenessofantimicrobialtherapymeasuredbyrepeatedprevalencesurveys AntimicrobAgentsChemother 2007Mar 51 3 864 7 Misuseofantibioticsdrivesantibioticresistance Studiesprovethatmisuseofantibioticsmaycausepatientstobecomecolonisedorinfectedwithantibiotic resistantbacteria suchas Meticillin resistantStaphylococcusaureus MRSA Vancomycin resistantenterococci VRE Highly resistantGram negativebacilli13 14E g E coli Klebsiellasp Pseudomonassp MisuseofantibioticsisalsoassociatedwithanincreasedincidenceofClostridiumdifficileinfections 15 17 20 13 SafdarN MakiDG Thecommonalityofriskfactorsfornosocomialcolonizationandinfectionwithantimicrobial resistantStaphylococcusaureus enterococcus gram negativebacilli Clostridiumdifficile andCandida AnnInternMed 2002Jun4 136 11 834 44 14 TacconelliE DeAngelisG CataldoMA MantengoliE SpanuT PanA etal Antibioticusageandriskofcolonizationandinfectionwithantibiotic resistantbacteria ahospitalpopulation basedstudy AntimicrobAgentsChemother 2009Oct 53 10 4264 9 15 DaveyP BrownE FenelonL FinchR GouldI HartmanG etal Interventionstoimproveantibioticprescribingpracticesforhospitalinpatients CochraneDatabaseSystRev 15 2005 4 CD003543 16 CarlingP FungT KillionA TerrinN BarzaM Favorableimpactofamultidisciplinaryantibioticmanagementprogramconductedduring7years InfectControlHospEpidemiol 2003Sep 24 9 699 706 17 FowlerS WebberA CooperBS PhimisterA PriceK CarterY etal SuccessfuluseoffeedbacktoimproveantibioticprescribingandreduceClostridiumdifficileinfection acontrolledinterruptedtimeseries JAntimicrobChemother 2007May 59 5 990 5 Whatismisuseofantibiotics 21 Misuseofantibioticscanincludeanyofthefollowing18 Whenantibioticsareprescribedunnecessarily Whenantibioticadministrationisdelayedincriticallyillpatients Whenbroad spectrumantibioticsareusedtoogenerously orwhennarrow spectrumantibioticsareusedincorrectly Whenthedoseofantibioticsislowerorhigherthanappropriateforthespecificpatient Whenthedurationofantibiotictreatmentistooshortortoolong Whenantibiotictreatmentisnotstreamlinedaccordingtomicrobiologicalculturedataresults 18 GyssensIC vandenBroekPJ KullbergBJ HeksterY vanderMeerJW Optimizingantimicrobialtherapy Amethodforantimicrobialdruguseevaluation JAntimicrobChemother 1992Nov 30 5 724 7 Benefitsofprudentuseofantibiotics Prudentuseofantibioticscanpreventtheemergenceandselectionofantibiotic resistantbacteria 19 23DecreasingantibioticusehavealsobeenshowntoresultinlowerincidenceofClostridiumdifficileinfections 24 26 RatesofVancomycin resistantEnterococciinhospitalbeforeandafterimplementationoftheantibioticmanagementprogramcomparedwithratesinNationalNosocomialInfectionsSurveillance NNIS System hospitalsofsimilarsize 27 NNISisnowtheNationalHealthcareSafetyNetwork NHSN RatesofnosocomialClostridiumdifficile expressedper1 000patient days beforeandafterimplementationoftheantibioticmanagementprogram 28 22 19 24 DaveyP BrownE FenelonL FinchR GouldI HartmanG etal Interventionstoimproveantibioticprescribingpracticesforhospitalinpatients CochraneDatabaseSystRev 2005 4 CD003543 20 LepperPM GrusaE ReichlH HogelJ TrautmannM Consumptionofimipenemcorrelateswithbeta lactamresistanceinPseudomonasaeruginosa AntimicrobAgentsChemother 2002Sep 46 9 2920 5 21 25 27 28 CarlingP FungT KillionA TerrinN BarzaM Favorableimpactofamultidisciplinaryantibioticmanagementprogramconductedduring7years InfectControlHospEpidemiol 2003Sep 24 9 699 706 22 BradleySJ WilsonAL AllenMC SherHA GoldstoneAH ScottGM Thecontrolofhyperendemicglycopeptide resistantEnterococcusspp onahaematologyunitbychangingantibioticusage JAntimicrobChemother 23 DeManP VerhoevenBAN VerbrughHA VosMC VanDenAnkerJN Anantibioticpolicytopreventemergenceofresistantbacilli Lancet 2000 355 9208 973 8 26 BylB ClevenberghP JacobsF StruelensMJ ZechF KentosA etal Impactofinfectiousdiseasesspecialistsandmicrobiologicaldataontheappropriatenessofantimicrobialtherapyforbacteremia ClinInfectDis 1999Jul 29 1 60 6 discussion7 8 Howprudentuseofantibioticscanbepromotedinhospitals the how 23 Multifacetedstrategiescanaddressanddecreaseantibioticresistanceinhospitals Antibioticprescribingpracticesanddecreasingantibioticresistancecanbeaddressedthroughmultifacetedstrategiesincluding 29 31UseofongoingeducationUseofevidence basedhospitalantibioticguidelinesandpoliciesRestrictivemeasuresandconsultationsfrommicrobiologists infectiousdiseasephysiciansandpharmacists 24 29 DaveyP BrownE FenelonL FinchR GouldI HartmanG etal Interventionstoimproveantibioticprescribingpracticesforhospitalinpatients CochraneDatabaseSystRev 2005 4 CD003543 30 CarlingP FungT KillionA TerrinN BarzaM Favorableimpactofamultidisciplinaryantibioticmanagementprogramconductedduring7years InfectControlHospEpidemiol 2003Sep 24 9 699 706 31 BylB ClevenberghP JacobsF StruelensMJ ZechF KentosA etal Impactofinfectiousdiseasesspecialistsandmicrobiologicaldataontheappropriatenessofantimicrobialtherapyforbacteremia ClinInfectDis 1999Jul 29 1 60 6 discussion7 8 Measuresthatcandecreaseantibioticresistance 25 Measuresthatguideantibioticprescribingarelikelytodecreaseantibioticresistanceinhospitals 32 34Suchmeasuresinclude ObtainingculturesTakeappropriateandearlyculturesbeforeinitiatingempiricantibiotictherapy andstreamlineantibiotictreatmentbasedonthecultureresults35MonitoringlocalantibioticresistancepatternsBeingawareoflocalantibioticresistancepatterns antibiograms enablesappropriateselectionofinitialempiricantibiotictherapy36ConsultingspecialistsInvolveinfectiousdiseasephysicians microbiologistsandpharmacistsinyourdecisionsaboutantibiotictherapyduringyourpatient sstay37 39 32 37 DaveyP BrownE FenelonL FinchR GouldI HartmanG etal Interventionstoimproveantibioticprescribingpracticesforhospitalinpatients CochraneDatabaseSystRev 2005 4 CD00354333 38 CarlingP FungT KillionA TerrinN BarzaM Favorableimpactofamultidisciplinaryantibioticmanagementprogramconductedduring7years InfectControlHospEpidemiol 2003Sep 24 9 699 706 34 39 BylB ClevenberghP JacobsF StruelensMJ ZechF KentosA etal Impactofinfectiousdiseasesspecialistsandmicrobiologicaldataontheappropriatenessofantimicrobialtherapyforbacteremia ClinInfectDis 1999Jul 29 1 60 6 discussion7 8 35 RelloJ GallegoM MariscalD SonoraR VallesJ Thevalueofroutinemicrobialinvestigationinventilator associatedpneumonia AmJRespirCritCareMed 1997Jul 156 1 196 200 36 BeardsleyJR WilliamsonJC JohnsonJW OhlCA KarchmerTB BowtonDL Usinglocalmicrobiologicdatatodevelopinstitution specificguidelinesforthetreatmentofhospital acquiredpneumonia Chest 2006Sep 130 3 787 93 Ourhospitaltoolsforprudentantibioticprescribing Hospitalantibiogramifavailable Hospitalguidelinesifavailable Antibioticstewardshipcommitteeifitexists Namesofinfectiousdiseases antibioticexperts 26 Antibiotics handlewithcare Misuseofantibioticsleadstoresistance40 42Allhospitalpractitionerscanplayanactiveroleinreversingthetrendofantibiotic resistantbacteria Takeculturesbeforestartingantibiotictherapy43Consultthehospitalantibioticexpert44 46 localantibiogram andhospitalantibioticguidelines Streamlineantibiotictherapybasedoncultureresults47 27 40 SinghN YuVL RationalempiricantibioticprescriptionintheICU Chest 2000May 117 5 1496 9 41 LeschCA ItokazuGS DanzigerLH WeinsteinRA Multi hospitalanalysisofantimicrobialusageandresistancetrends DiagnMicrobiolInfectDis 2001Nov 41 3 149 54 42 LepperPM GrusaE ReichlH HogelJ Trautm