RESISTANCE TO ANTIBIOTICS IN BELGIUM AMR Policy … to antibiotics in Belgium... · Autocontrole 46...

RESISTANCE TO ANTIBIOTICS IN BELGIUM

AMR Policy DialogueNovember 22, 2018

Boudewijn Catry Service Healthcare-associated infections and antimicrobial resistance

Point prevalence survey: PPS (photo)

Surveillance continue (film)

&

Conclusion on ‘Pictures’

Healthcare associated infections (HAI) prevalence (%) in Belgium• Hospitals: 7.3 (2017)• Long term care facilities (LTCFs): 3.5 (2016)

Estimated number of patients per year with an HAI in Belgium• Hospital: 111 276• LTCFs: 170 090

Disability adjusted lifye years (DALY) calculations:Throughout Europe, this study concluded that an estimated number of 33 000 casualties are annually attributed toantimicrobial resistance. For Belgium, this number has been estimated at 530 deaths annually. Among these, 240 and 70could be attributed to third-generation cephalosporin resistant Escherichia coli and Klebsiella pneumoniae (excludingthose resistant to colistin and/or carbapenem), respectively, and 133 to MRSA (methicillin resistant Staphylococcus aureus).Further actions should focus on a reduction of inappropriate antimicrobial consumption and adequate preventive measuresincluding hand hygiene and other infection control policies.

Latour Katrien & Eline VandaelBrecht Devleeschauwer

Surveillances

&

FEEDBACKMRSA

Campaigns

IndicatorsICU & SSIBlood stream infections

C. difficile

Gram -

BeH-SAC

Rectangle = mandatory

VRE

MULTIDRUG RESISTANT ORGANISMS

Microorganism ResistanceMRSA Staphylococcus aureus Met(h)icillinESBL+ Enterobacteriaceae

(E.coli / Klebsiella / …)3de generation cephalosporins

CPE Enterobacteriaceae CarbapenemsVRE Enterococcus faecalis/faecium VancomycinMDR Pseudomonas/Acinetobacter Different classes

CDIF Clostridium difficile Intrinsic (Anaërobic)

Urgent inquiries*

e.g. Candida auris, Mycobacterium chimaera

Intrinsic antibacterial, and/or multi antifungal resistance

Latour Katrien*ECDC

CB1CB2

CB1 Catry, Boudewijn; 29/06/18

CB2 Catry, Boudewijn; 29/06/18

Skin (MRSA) versus Gut bacteria (ESBL, CPE), Belgium 1994-2017

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Incidence of MRSA and ESBL+ and CPE+ E. coli & K. pneumoniae per 1000 admissions(Belgian acute care hospitals; clinical samples only)

1994 - 2017

ESBL+ Escherichia coli ESBL+ Klebsiella pneumoniae #REF! CPE+ Klebsiella pneumoniae MRSA

MRSA: methicillin resistant Staphylococcus aureus; ESBL: extended spectrum beta-lactamaseCPE: carbapenemase producingKatrien Latour & Béatrice Jans

Timely feedback is needed, also for outbreak support team (OST)

EARS-net Belgium , S. aureus, E. col i , E. faecium blood, evolut ion of mult iple resistance, 2013-2017

Mertens, K in press

EARS-net Belgium, E. coli (Urine vs Blood)

Mertens, K in press

Remarkable findings 2017Earsnet-Belgium Blood/CSF*

• S. aureus: decline MRSA: 8.7%IR in 2017 (versus 12.2%IR in 2016)

• E. coli: no increase in multi-resistance• K. pneumoniae: no further increase R% for 3GC and carbapenems• E. faecium: rise in resistance% vancomycin (5.5%R versus

1.7%R in 2016), teicoplanine (6.5%R versus 1.2%R in 2016) and linezolid (2.4%R versus 0.5%R in 2016)

*Preliminary results – validation by NRC’s ongoing

Thomas Struyf – Karl Mertens

Preliminary results

Surveillances

&

FEEDBACKMRSA

Campaigns

IndicatorsICU & SSIBlood stream infections

C. difficile

Gram -

BeH-SAC

Rectangle = mandatory

VRE

Clostridium difficile – mean incidence per 1000 admissions (BE 2008-2017)

NOTE: - ICD associées à l’hôpital: début des symptômes ≥ 2 jours après l’admission- Calcul de l’incidence: Inclusion de tous les hôpitaux ayant fourni des données complètes (numérateurs et dénominateurs)

au moins 1 semestre/an

Incidence moyenne des infections à C. difficile (ICD) dans les hôpitaux aigus,[Belgique 2008-2017]

0.00

0.50

1.00

1.50

2.00

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

N/1

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adm

issi

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ICD associés à l'hopital Total des ICD

1.75

1

Mortgat ea., in press

Clostridium diff ici le (CDIF), stratif ied by province (BE, 2017)

Note: Incidence moyenne de tous les hôpitaux aigus ayant participé à au moins 1 semestre. Les chiffres pour chaque province indiquent le nombre d’hôpitaux-semestres. Les catégories (couleurs) pour l’incidence sont basées sur les quartiles de la distribution.

Incidence moyenne des infections à C. difficiles (ICD) dans les hôpitaux aigus, par province[N/10.000 journées d’hospitalisation, Belgique 2017]

Mortgat ea., in press

Relationship Infuenza like illnes –antimicrobial consumption - CDIF

Figuur 1Non-pediatric antimicrobial use in the community in Daily Defined Doses per 1000 inhabitant days. Belgium 2007-2013

Bruyndonckx et al., submitted

• Competent authorities

Outbreak

Surveillance & notification

• experts

Outbreak support

Reference labSCIENSANO

Elisabeth Miller & Hélène De Pauw

Enkele gegevens

Enterobacteriaceae

Enterobacteriaceae

EnterobacteriaceaeEnterobacteriaceae

Miller E, De Pauw H

Compliance hand hygiene

De Pauw H, Benhammadi N, et al. 2018

Compliance stratified by indication


Compliance HH before ‘sterile or invasive contact’


Compliance Hand hygiene in ICU – BE

( F o n g u h e t a l . A r c h i v e s P u b l i c H e a l t h 2 0 1 6 )

M e r t e n s , 2 0 1 7 W I V- I S P

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IZ verworven

Intubatie geassocieerd

Intubatie gebruik

Figuur 2: Evolutie van IZ-verworven en intubatie geassocieerde pneumoniën, en intubatie gebruik op Intensieve Zorgen, NSIH-ICU surveillance België, 1997-2015.

Mertens K, WIV-ISP 2017

Ventilator associated pneumonia, ICU BE 1997-2015

Blood stream infections (BSI)

Figure 10: Variation hospital-associated bloodstream infections between hospitals, Belgium 2017 (HABSI, hospital-associated bloodstream infection; SD, standard deviation)

Duysburgh, E. 2018

Recoded Pneumonia & Sepsis for the sake of economic benefits

• Competent authorities

Outbreak

Surveillance & notification

• experts

Outbreak support

Reference labSCIENSANO

Elisabeth Miller & Hélène De Pauw

https://www.healthstat.be

Evolut ion of the consumption* of ant ibacter ials for systemic use (J01) in acute-care Belgian hospitals, 2003-2016

Vandael Eline et al., in prep.

RIZIV/INAMI & Healthdata

*Expressed in defined daily doses (DDDs)/1000 patient days (2003-2016)

Currently 18 months delayrealtime monitoring is asked

Anticaterial use (J01) stratified by type of hospitals

Stratification BSI by hospital type

Duysburgh E. 2018

Blood stream infections – stratified by region

Duysburgh E. 2018

Evolut ion of the consumption* of ant ibacter ials for systemic use (J01) in acute-care Belgian hospitals, 2003-2016

Vandael Eline et al., in prep.

RIZIV/INAMI & Healthdata

*Expressed in defined daily doses (DDDs)/1000 patient days (2003-2016)

Antibacterial consumption Belgium, 2017

Antibacterials for systemic use (ATC group J01)

Consumption of antibacterials for systemic use (ATC group J01) in the community (primary care sector) and the hospital sector expressed in DDD per 1000 inhabitants and per day in 2017

ATC group J01 Community (primary care sector)

Hospital sector

Beta-lactam antibacterials, penicillins (J01C) 14.48 0.97

Other beta-lactam antibacterials (J01D) 1.17 0.40

Tetracyclines (J01A) 1.92 0.02

Macrolides, lincosamides and streptogramins (J01F) 3.41 0.11

Quinolone antibacterials (J01M) 2.17 0.19

Sulfonamides and trimethoprim (J01E) 0.19 0.04

Other J01 substances 2.55 0.16

Total 25.89 1.89

EARS-net Belgium

Mertens, K in press

Consumption per animal species(DDD/1000 individual per day)

32

Persoons et al., 2012 Callens et al., 2012 Catry et al., 2016 Pardon et al., 2012

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poultry pigs dairy cattle beef cattle veal calves

Treatm

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treaed

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Antimicrobial use in livestock in Belgium

Courtesy: B. Pardon, UGent

BelVetSac.ugent.be

Results prevalence 2011-2017:Descriptive Statistics

Resistance >50% 2011-2017 Ampicillin, Tetracycline, SulphamethoxazoleTrimethoprim

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Resistance strains prevalenceVeal calves - E. coli

Ampicillin

Sulphamethoxazole

Tetracycline

Trimethoprim

Results prevalence 2011-2017:Descriptive Statistics

Sulphamethoxazole: 22,50 % (2017)

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Resistance strains prevalenceBeef cattle - E. coli

Ampicillin

Chloramphenicol

Gentamicin

Nalidixic acid

Sulphamethoxazole

Tetracycline

Trimethoprim

N E. coli = >27 000; 5808; 812 (2005-2015)

Campylobacter jejuni in Poultry Meat (2017)

• % Sensible stable

• Co-R to CipNalTet (2 AB families) remains high and stable

S a l m o n e l l a P o r c i n e m e a t ( P R I 0 3 1 ) E U - A M R

Project nEU AMR Autocontrole 46

EU AMR Gembloux 17

EU AMR Melle 38Total 101

Famille d’AB n %sensible 24 26.371 10 10.992 6 6.59≥3 51 56.04

Antimicrobial consumption (J01) per animal species

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Treatm

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Anticaterial use (J01) stratified by type of hospitals

Vandael et al, 2018

EARS-net Belgium

Mertens, K in press


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Antibacterial use Belgium, Intensive care vs hospital wide

Vandael et al., 2018


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Antibacterial consumption Belgium, 2017

Antibacterials for systemic use (ATC group J01)

Consumption of antibacterials for systemic use (ATC group J01) in the community (primary care sector) and the hospital sector expressed in DDD per 1000 inhabitants and per day in 2017

ATC group J01 Community (primary care sector)

Hospital sector

Beta-lactam antibacterials, penicillins (J01C) 14.48 0.97

Other beta-lactam antibacterials (J01D) 1.17 0.40

Tetracyclines (J01A) 1.92 0.02

Macrolides, lincosamides and streptogramins (J01F) 3.41 0.11

Quinolone antibacterials (J01M) 2.17 0.19

Sulfonamides and trimethoprim (J01E) 0.19 0.04

Other J01 substances 2.55 0.16

Total 25.89 1.89

577,1 (2016)

Concluding remarks

Focus on hospital consumption, stratified by type of hospitals

Reflection in tertiary hospitals is urgently needed, in particular ICU

(e.g. Guidelines vs Systematic reviews)

Do no limit focus on acquired multidrug resistance

(HAI at large, CDIF, ILI, mycoses, adverse events….)

- Hand hygiene campaigns should be further elaborated

Requirements: realtime feedback AM consumption

= Prerequisite for containment during outbreaks (Outbreak support team)

- allows also rapid evaluation of (inter)national intervention strategies

One health: direct contact with animals has been underestimated for years

Future deliverable: AM & AMR geographical mapping, stratified and open data

Acute care hospitals, AB consumption

Vandael et al., 2018

Acknowledgements: The NSIH team, BAPCOC, NRCs

the labs & hospitals & nursing homes & healthcare workers

[email protected]@sciensano.be

RESISTANCE TO ANTIBIOTICS IN BELGIUM AMR Policy … to antibiotics in Belgium... · Autocontrole 46...

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Transcript of RESISTANCE TO ANTIBIOTICS IN BELGIUM AMR Policy … to antibiotics in Belgium... · Autocontrole 46...