European Antibiotic Awareness Day 2009

What is the problem? ― Latest data on antibiotic resistanceZsuzsanna Jakab, ECDC DirectorLaunch Seminar for EAAD

Stockholm, 18 November 2009

Fluoroquinolone-resistant Escherichia coli in EU/EEA countries

2003 2008

Source: European Antimicrobial Resistance Surveillance System (EARSS), 2008

Methicillin-resistant Staphylococcus aureus (MRSA), blood and spinal fluid

2003 2008

Source: European Antimicrobial Resistance Surveillance System (EARSS), 2008

Relationship between antibiotic useand resistance in the community

R2=0.66

P<0.001

0

20

40

60

0 2 4 6 8

Antibiotic consumption(Outpatient consumption of

macrolides and lincosamides,

DDD per 1,000 inh-days, 1997)

Antibio

tic

resi

stance

(%M

acr

olid

e-R

S. pneum

onia

e

from

com

munity-

acq

uired R

TIs

, 1998)

Each data point represents one country

Source: Alexander Project; FINRES; STRAMA; DANMAP; Cars et al., 2001.

Antibiotic prescribing and consumption vary between European countries

Source: European Surveillance of Antimicrobial Consumption (ESAC), 2008

0

5

10

15

20

25

30

35

40

Cyp

rus*

Gre

ece

*,*

*

Fra

nce

Italy

Luxe

mbourg

Belg

ium

Slo

vaki

a

Irela

nd

Port

ugal

Bulg

aria

Icela

nd**

Spain

***

Pola

nd**

Fin

land

Lithuania

*,*

*

Cze

ch R

epublic

Denm

ark

Slo

venia

Est

onia

*

Sw

eden

Hungary

United K

ingdom

**

Norw

ay

Aust

ria

Germ

any*

*

Latv

ia

Neth

erlands

DD

D p

er

1000 inhabitants

and p

er

day

Other J01 classes (J01B, J01G, J01R, J01X)

Sulfonamides and trimethoprim (J01E)

Quinolones (J01M)

Macrolides, lincosamides and streptogramins (J01F)

Tetracyclines (J01A)

Cephalosporins and other beta-lactams (J01D)

Penicillins (J01C)

*Total use, i.e. including inpatients, for Cyprus, Estonia, Greece and Lithuania.

**2006 data for Germany, Greece, Iceland and Lithuania; 2005 data for Poland and United Kingdom.

***Reimbursement data, which do not include over-the-counter sales without prescription.

Modern medicine is not possible without effective antimicrobials

Hip replacement

Organ transplants

Cancer chemotherapy

Intensive care

Care of preterm babies

Animated slide: please waitPhoto by interplast (http://www.flickr.com/photos/interplast/115125072), reproduced under a Creative Commons license.

Survey results on intensive-care patients infected with resistant bacteria

0 20 40 60 80 100

% respondents

Gram-positivebacteria

Gram-negativebacteria

Bacteria totally or almost totallyresistant to available antibiotics

Carbapenem-resistant Enterobacteriaceae

Carbapenem-resistant Acinetobacter spp.

Carbapenem-resistant Pseudomonas aeruginosa

Third-generation cephalosporin-resistant Enterobacteriaceae

Vancomycin-resistant/intermediate S. aureus (VRSA/VISA)

Penicillin-resistant Streptococcus pneumoniae (PRSP)

Vancomycin-resistant Enterococcus spp. (VRE)

Methicillin-resistant Staphylococcus aureus (MRSA)

>10 patients 3-10 patients 1-2 patients 0 Do not know Missing

Source: Eurosurveillance, 12 Nov 2009. Alain Lepape, Dominique L. Monnet, on behalf of participating members of the European Society of Intensive Care Medicine (ESICM)

How can we stop antibiotic resistance?

• Prudent use of antibiotics (only when needed, correct dose, dose intervals, duration).

• Infection control (hand hygiene, screening, isolation).

• Development of new antibiotics (focus of Swedish EU Presidency).

www.se2009.eu

ECDC’s Antimicrobial Resistance and Healthcare-Associated Infections Programme

• Pan-European surveillance of antibiotic resistance and antibiotic consumption (outsourced).

• Ad-hoc surveys and reports when surveillance does not exist.

• Risk assessments and guidance for the prevention and control of multidrug-resistant bacteria.

• Coordination of activities through a network of National AMR Focal Points (one per country).

• Country visits to discuss AMR issues on the basis of Council Recommendation 2002/77/EC (upon invitation from the country).

• Communication.

European Antibiotic Awareness Day —targeting prudent antibiotic use

• Targeting prudent antibiotic use in primary care.

• Message – 'Cold? Flu? Take care, not antibiotics!'

• Materials targeting primary care prescribers.

• TV and Web spots

European Antibiotic Awareness Day –multilingual website

European Antibiotic Awareness Day:What is happening across Europe today

Slovenia: TV spot; point-prevalence study on antibiotic consumption in children at primary level.

France: Press release on actions organised in France; launch of French MoH antibiotic website with up-to-date treatment recommendations for clinicians; local and regional level events.

Czech Republic: Round table meeting with stakeholder representatives to mark EAAD, organised with support of WHO office; special issue of Bulletin of Association of General Practitioners with distribution for free to 5000 GPs.

Sweden: Joint launch seminar and press release with ECDC and Swedish EU Presidency; TV spots broadcast in cinema theatres; many STRAMA activities.

Spain: Scientific conferences in Madrid and Barcelona; press conference by professional societies.

Belgium: Launch of 9th national campaign, including TV spot, website, letter plus posters and leaflets to GPs and pharmacists; special issue of Huisarts Nu devoted to EAAD.

Hungary: National scientific conference and press conference with participation of Minister for Health and Chief Medical Officer; TV spots on main and regional channels.

ECDC working closely with EU Presidencies

• ECDC is working closely in support of the EU Presidency countries to keep antibiotic resistance high on the EU agenda.

• Swedish EU Presidency

− ECDC-EMEA joint report on 'The bacterial challenge – time to react' was published for the EU conference 'Innovative incentives for effective antibacterials' in Stockholm on 17 September.

− EU/US Joint Taskforce on AMR is being created following the last US-EU Summit in Washington (DC) on 3-4 November.

− In 2010, the US CDC will launch its 'Get smart' campaign on prudent use of antibiotics on 18 November.

• In 2010, European Antibiotic Awareness Day will focus on hospitals, and the EU Presidency countries will continue to prioritise AMR:– Spain: patient safety and infection control.– Belgium: healthcare acquired infections and antibiotic use.

• ECDC is already working with WHO Euro to promote the campaign beyond the EU borders.

Thank you!