抗生素的慎重使用(英文)European-Antibiotics-Awarness-Day课件.ppt

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1、Insert Name of presenterInsert Name of hospitalUsing antibiotics prudently-HospitalPrescriberPresentationContents of this presentationAntibioticresistanceapatientsafetyissueSituationinIrelandDriversofantibioticresistanceConsequencesofantibioticresistanceWhyinappropriateuseofantibioticscontributestoa

2、ntibioticresistancethe“why”Howprudentuseofantibioticscanbepromotedinhospitalsthe“how”EuropeanAntibioticAwarenessDayacampaigntopromoteprudentuseofantibiotics2Antibiotic resistance a patient safety issue3Antibiotic resistance a problem in the present and the futureAntibioticresistanceisanincreasinglys

3、eriouspublichealthproblem:resistantbacteriahavebecomeaneverydayconcerninIrishhospitals.4Trends in antibiotic resistance(invasive infections)in Ireland,2002-2009.Source:European Antimicrobial Resistance Surveillance System(EARSS)and Health Protection Surveillance Centre(HPSC).S.aureus/MRSA bacteraemi

4、a trends by quarter,2002-2010Q2*Data for 2010 provisional up to the end of Q2;Number of laboratories participating by year-end indicated above the Q4 barsMRSA in Europe,2007:often high,but decreasing in many countriesCountrywithasignificantincrease(20052007)Countrywithasignificantdecrease(20052007)M

5、RSA(%)Source:EARSS&ECDC,2009No.of countries7IrelandAntimicrobial resistance in gram-negative bacteria,EU,2007:already high or increasingCountrywithasignificantincrease(2005-2007)Countrywithasignificantdecrease(2005-2007)Carbapenem-resistant Pseudomonas aeruginosa(%)3rd-gen.ceph.-resistant Klebsiella

6、 pneumoniae(%)3rd-gen.ceph.-resistant Escherichia coli(%)Source:EARSS&ECDC,2009No.of countriesNo.of countries8Antibiotic consumption in acute hospitals in Ireland:2007 to Q2 2010Data source:HPSCFluoroquinolone consumption in acute hospitals in Ireland:2007 to Q2 201011Data source:HPSCHospital antibi

7、otic prevalence survey,2009:indications for antibiotic use13Antibiotic use at(insert hospital name)Insert individual hospital antibiotic consumption data,available from hospital pharmacist or from Ajay Oza at HPSCAntibiotic resistance A patient safety issue for all hospitalsTheemergence,selectionand

8、spreadofresistantbacteriainhospitalsisamajorpatientsafetyissue.Infectionswithantibiotic-resistantbacteriacanresultinincreasedpatientmorbidityandmortality,aswellasincreasedhospitallengthofstay.1-2Antibioticresistancefrequentlyleadstoadelayinappropriateantibiotictherapy.3Inappropriateordelayedantibiot

9、ictherapyinpatientswithsevereinfectionsisassociatedwithworsepatientoutcomesandsometimesdeath.4-6161.Cosgrove SE,Carmeli Y.The impact of antimicrobial resistance on health and economic outcomes.Clin Infect Dis.2003 Jun 1;36(11):1433-7.2.Roberts RR,Hota B,Ahmad I,Scott RD,2nd,Foster SD,Abbasi F,et al.

10、Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital:implications for antibiotic stewardship.Clin Infect Dis.2009 Oct 15;49(8):1175-84.3.Kollef MH,Sherman G,Ward S,Fraser VJ.Inadequate antimicrobial treatment of infections:a risk factor for hospital mortal

11、ity among critically ill patients.Chest.1999 Feb;115(2):462-74.4.Ibrahim EH,Sherman G,Ward S,Fraser VJ,Kollef MH.The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting.Chest.2000 Jul;118(1):146-55.5.Lodise TP,McKinnon PS,Swiderski L,Rybak

12、 MJ.Outcomes analysis of delayed antibiotic treatment for hospital-acquired Staphylococcus aureus bacteremia.Clin Infect Dis.2003 Jun 1;36(11):1418-23.6.Alvarez-Lerma F.Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit.ICU-Acquired neumonia S

13、tudy Group.Intensive Care Med.1996 May;22(5):387-94.Why inappropriate use of antibiotics contributes to antibiotic resistance the“why”18In-patients are at high risk of antibiotic-resistant infectionsMisuseofantibioticsinhospitalsisoneofthemainfactorsthatdrivedevelopmentofantibioticresistance.7-9Pati

14、entsinhospitalshaveahighprobabilityofreceivinganantibiotic10and50%ofallantibioticuseinhospitalscanbeinappropriate.11-12Ina2009prevalencesurveyofantibioticuseinIrishhospitals:34%ofpatientswerereceivingantibioticsonthedayofthesurvey42%ofantibioticusedidnotfollowevidence-basedguidelines197.Singh N,Yu V

15、L.Rational empiric antibiotic prescription in the ICU.Chest.2000 May;117(5):1496-9.8.Lesch CA,Itokazu GS,Danziger LH,Weinstein RA.Multi-hospital analysis of antimicrobial usage and resistance trends.Diagn Microbiol Infect Dis.2001 Nov;41(3):149-54.9.Lepper PM,Grusa E,Reichl H,Hogel J,Trautmann M.Con

16、sumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa.Antimicrob Agents Chemother.2002 Sep;46(9):2920-5.10.Ansari F,Erntell M,Goossens H,Davey P.The European surveillance of antimicrobial consumption(ESAC)point-prevalence survey of antibacterial use in 20 European hos

17、pitals in 2006.Clin Infect Dis.2009 Nov 15;49(10):1496-504.11.Davey P,Brown E,Fenelon L,Finch R,Gould I,Hartman G,et al.Interventions to improve antibiotic prescribing practices for hospital inpatients.Cochrane Database Syst Rev.2005(4):CD003543.12.Willemsen I,Groenhuijzen A,Bogaers D,Stuurman A,van

18、 Keulen P,Kluytmans J.Appropriateness of antimicrobial therapy measured by repeated prevalence surveys.Antimicrob Agents Chemother.2007 Mar;51(3):864-7.Misuse of antibiotics drives antibiotic resistanceStudiesprovethatmisuseofantibioticsmaycausepatientstobecomecolonisedorinfectedwithantibiotic-resis

19、tantbacteria,suchas;Meticillin-resistantStaphylococcus aureus(MRSA)Vancomycin-resistantenterococci(VRE)Highly-resistantGram-negative bacilli 13-14E.g.E.coli,Klebsiella sp.,Pseudomonas sp.MisuseofantibioticsisalsoassociatedwithanincreasedincidenceofClostridium difficile infections.15-172013.Safdar N,

20、Maki DG.The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus,enterococcus,gram-negative bacilli,Clostridium difficile,and Candida.Ann Intern Med.2002 Jun 4;136(11):834-44.14.Tacconelli E,De Angelis G,Cataldo MA,Mantengoli E,Span

21、u T,Pan A,et al.Antibiotic usage and risk of colonization and infection with antibiotic-resistant bacteria:a hospital population-based study.Antimicrob Agents Chemother.2009 Oct;53(10):4264-9.15.Davey P,Brown E,Fenelon L,Finch R,Gould I,Hartman G,et al.Interventions to improve antibiotic prescribing

22、 practices for hospital inpatients.Cochrane Database Syst Rev.15.2005(4):CD003543.16.Carling P,Fung T,Killion A,Terrin N,Barza M.Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years.Infect Control Hosp Epidemiol.2003 Sep;24(9):699-706.17.Fowler S,Webber A,Co

23、oper BS,Phimister A,Price K,Carter Y,et al.Successful use of feedback to improve antibiotic prescribing and reduce Clostridium difficile infection:a controlled interrupted time series.J Antimicrob Chemother.2007 May;59(5):990-5.What is misuse of antibiotics?21Misuse of antibiotics can include any of

24、 the following18:Whenantibioticsareprescribedunnecessarily;Whenantibioticadministrationisdelayedincriticallyillpatients;Whenbroad-spectrumantibioticsareusedtoogenerously,orwhennarrow-spectrumantibioticsareusedincorrectly;Whenthedoseofantibioticsislowerorhigherthanappropriateforthespecificpatient;Whe

25、nthedurationofantibiotictreatmentistooshortortoolong;Whenantibiotictreatmentisnotstreamlinedaccordingtomicrobiologicalculturedataresults.18.Gyssens IC,van den Broek PJ,Kullberg BJ,Hekster Y,van der Meer JW.Optimizing antimicrobial therapy.A method for antimicrobial drug use evaluation.J Antimicrob C

26、hemother.1992 Nov;30(5):724-7.Benefits of prudent use of antibioticsPrudentuseofantibioticscanpreventtheemergenceandselectionofantibiotic-resistantbacteria.19-23DecreasingantibioticusehavealsobeenshowntoresultinlowerincidenceofClostridium difficile infections.24-26RatesofVancomycin-resistantEnteroco

27、cciinhospitalbeforeandafterimplementationoftheantibioticmanagementprogramcomparedwithratesinNationalNosocomialInfectionsSurveillance(NNIS)System*hospitalsofsimilarsize.27*NNISisnowtheNationalHealthcareSafetyNetwork(NHSN).RatesofnosocomialClostridium difficile,expressedper1,000patient-days,beforeanda

28、fterimplementationoftheantibioticmanagementprogram.282219,24.Davey P,Brown E,Fenelon L,Finch R,Gould I,Hartman G,et al.Interventions to improve antibiotic prescribing practices for hospital inpatients.Cochrane Database Syst Rev.2005(4):CD003543.20.Lepper PM,Grusa E,Reichl H,Hogel J,Trautmann M.Consu

29、mption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa.Antimicrob Agents Chemother.2002 Sep;46(9):2920-5.21,25,27,28.Carling P,Fung T,Killion A,Terrin N,Barza M.Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years.Infect Control

30、Hosp Epidemiol.2003 Sep;24(9):699-706.22.Bradley SJ,Wilson AL,Allen MC,Sher HA,Goldstone AH,Scott GM.The control of hyperendemic glycopeptide-resistant Enterococcus spp.on a haematology unit by changing antibiotic usage.J Antimicrob Chemother.23.De Man P,Verhoeven BAN,Verbrugh HA,Vos MC,Van Den Anke

31、r JN.An antibiotic policy to prevent emergence of resistant bacilli.Lancet.2000;355(9208):973-8.26.Byl B,Clevenbergh P,Jacobs F,Struelens MJ,Zech F,Kentos A,et al.Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia.Clin In

32、fect Dis.1999 Jul;29(1):60-6;discussion 7-8.Multifaceted strategies can address and decrease antibiotic resistance in hospitalsAntibioticprescribingpracticesanddecreasingantibioticresistancecanbeaddressedthroughmultifacetedstrategiesincluding:29-31UseofongoingeducationUseofevidence-basedhospitalanti

33、bioticguidelinesandpoliciesRestrictivemeasuresandconsultationsfrommicrobiologists,infectiousdiseasephysiciansandpharmacists2429.Davey P,Brown E,Fenelon L,Finch R,Gould I,Hartman G,et al.Interventions to improve antibiotic prescribing practices for hospital inpatients.Cochrane Database Syst Rev.2005(

34、4):CD003543.30.Carling P,Fung T,Killion A,Terrin N,Barza M.Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years.Infect Control Hosp Epidemiol.2003 Sep;24(9):699-706.31.Byl B,Clevenbergh P,Jacobs F,Struelens MJ,Zech F,Kentos A,et al.Impact of infectious disea

35、ses specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia.Clin Infect Dis.1999 Jul;29(1):60-6;discussion 7-8.Measures that can decrease antibiotic resistance25Measures that guide antibiotic prescribing are likely to decrease antibiotic resistance in hosp

36、itals.32-34 Such measures include:Obtaining culturesTake appropriate and early cultures before initiating empiric antibiotic therapy,and streamline antibiotic treatment based on the culture results35Monitoring local antibiotic resistance patternsBeing aware of local antibiotic resistance patterns(an

37、tibiograms)enables appropriate selection of initial empiric antibiotic therapy36Consulting specialistsInvolve infectious disease physicians,microbiologists and pharmacists in your decisions about antibiotic therapy during your patients stay37-3932,37.Davey P,Brown E,Fenelon L,Finch R,Gould I,Hartman

38、 G,et al.Interventions to improve antibiotic prescribing practices for hospital inpatients.Cochrane Database Syst Rev.2005(4):CD00354333,38.Carling P,Fung T,Killion A,Terrin N,Barza M.Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years.Infect Control Hosp E

39、pidemiol.2003 Sep;24(9):699-706.34,39.Byl B,Clevenbergh P,Jacobs F,Struelens MJ,Zech F,Kentos A,et al.Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia.Clin Infect Dis.1999 Jul;29(1):60-6;discussion 7-8.35.Rello J,Galleg

40、o M,Mariscal D,Sonora R,Valles J.The value of routine microbial investigation in ventilator-associated pneumonia.Am J Respir Crit Care Med.1997 Jul;156(1):196-200.36.Beardsley JR,Williamson JC,Johnson JW,Ohl CA,Karchmer TB,Bowton DL.Using local microbiologic data to develop institution-specific guid

41、elines for the treatment of hospital-acquired pneumonia.Chest.2006 Sep;130(3):787-93.Our hospital tools for prudent antibiotic prescribingHospitalantibiogramifavailableHospitalguidelinesifavailableAntibioticstewardshipcommitteeifitexistsNamesofinfectiousdiseases/antibioticexperts26European Antibioti

42、c Awareness Day a campaign to promote prudent use of antibiotics28About European Antibiotic Awareness DayEuropeanAntibioticAwarenessDayismarkedacrossEuropearound18November.EuropeanAntibioticAwarenessDayprovidesaplatformandsupporttonationalcampaignsaboutprudentantibioticuseinthecommunityandinhospitals.29THANK YOU!Formoreinformationondatasourcesandreferences,pleasevisit:3132