experiences from national-based surveillance systemes. milan cizman (slovenia)
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Experiences from national – based surveillance systems
Slovenia
Prof. Milan Čižman, MD Head of ICM
Tom Bajec Data manager Slovenian Surveillance AM
consumption team
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Demographic data
• Slovenia is a small country with 2.061.623 inhabitants according to the 2014 census
• Almost all inhabitants (>99%) have compulsory basic health insurance.
• No of hospitals 29 • No of hospital beds/1000 population in 2010:4.6
average EU 27: 5.3(2.7-8.3) • Surveillance of antibiotic consumption in hospitals
-1985,1990,1995-national
• -UMC-Lj –hospital and depart. level since1998
• -ESAC- 2001, national • -department- national consumption since 2006
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Slovenia Hospital Characteristics
Type of hospital Number of hospitals
Teaching 2
General 10
Special - Psychiatric
- Maternity
- Rehabilitation
- Lung
- Oncology
- Ortopedic surgery
- Nursing
- Private
17 5
2
2
2
1
1
1
3
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Annually tasks of consumption surveillance team
• Annually update of national list of AM products • Annually update of ATC and DDDs • Source of data: hospital pharmacists • In February each year the excel forms of all nationally available
antimicrobials are submitted to hospital pharmacists to fulfill (No of packages, units) for total hospital and separately for 5 departments
• The request for annual No of bed-days and No of admissions is sent to every hospital and NIPH
• The results of consumption using ATC/DDD methodology and expressed in DDD/100bed-days and DDD/100 admissions are latter available on the website
• Hospital pharmacist can compare their own data with the average data of the same type of hospital or department
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Surveillance of hospital antibiotic consumption in Slovenia
Location: Ljubljana
Internet server Database server
ESACS
Database
Firewall
Internet
Location: Maribor
Hospital 1
Lokacija: Ljubljana
Hospital 2Hospital 3
Location
User x
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Use of antibiotics (J01) in Slovenia 2008-2013 2008 2009 2010 2011 2012 2013
No of beds 9 587 9 389 9 367 9 493 9 349 9 377
No of
admissions
372 575 369 648 363 505 379 206 374 602 370 994
No of bed-
days
2 584 591 2 555 080 2 461 870 2 465262 2 446 111 2 439 895
Average
lenght of
stay
6.9 6.9 6.7 6.5 6.5 6.6
DDD/100
bed-days
48.25 50.95 52.26
50.43 47.88 47.65
DDD/100
admissions
342.28 365.33 356.38
327.88 312.64 313.36
DDD/TID 1.69 1.75 1.72 1.66 1.56 1.55
Source of data NIPH
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Use of antibiotics (J01) in Slovenia 2008 vs 2013
2008 2013 ∆ % 2008 vs
2013
No of beds 9 587 9 377 - 2.2
No of admissions 372 575 370 994 - 0.5
No of bed-days 2 584 591 2 439 895 - 5.6
Average lenght of
stay
6.9 6.6 - 4.4
DDD/100 bed-days 48.25 47,65 - 1.3
DDD/100 admissions 342.28 313,36 - 8.5
DDD/TID 1.69
1.55 -8.3
Cost(EUR)
N=24
21 922 150 12 442 584 -43.3
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Consumption (DDD/100 admissions) of antibiotics in Slovenia, Denmark, Sweden and the Netherlands in 2011-2013
Country Hospitals 2011 2012 2013
Slovenia All 328 313 313
Slovenia university +
general
308 333 325
Denmark1 somatic 283 304 309
Sweden2 somatic, 273 279 265
The
Netherlands3
72/91hosp.
teaching +
general
306 296 NA
NA – not available, 1Danmap, 2Swedres, 3Nethmap
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Total use of antibiotics (DDD/100bed -days) according to the type of hospital 2013 - 2012
0
10
20
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Hospital use of cephalosporins in Slovenian hospitals 1997-2013 (DDD / 100 bed-days)
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Consumption (DDD/100 adm) of cephalosporins in Slovenian hospitals in 2013
0
20
40
60
80
100
120
140
160
180
200
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NM
SGD
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Cephalosporin 3. gen (J01DD)
Cephalosporin 1. gen (J01DB)
Cephalosporin 2. gen (J01DC)
Cephalosporin 4. gen (J01DE)
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Hospital use of carbapenems in Slovenian hospitals 1997-2013 (DDD / 100 bed-days)
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Consumption of antibiotics (DDD/100 bed-days) in different
deparments Slovenia 2013
0
50
100
150
200
250
300
350
MICU SICU MxICU Surgery Medicine Gynecology Paediatrics
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40,40 40,20 35,31
33,35 32,67
29,85 29,55 28,35 26,49
25,92 25,73 18,74
26,14 22,08 20,28
25,20 31,02
22,48 28,35 28,66 29,89
24,20 32,36 24,94
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LJ CE JES NM BRE MB IZ SG TRB PT MS NG
Consumption of antibiotics(DDD/100 bed-days) in University and General hospitals in Slovenia 2013
O
P
I
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2,26 3,12
2,60
3,15
2,90
1,75
2,87 3,56
0,97
3,60
2,45 2,17
2,45 3,43
4,90
2,73
4,97
4,99
2,91 3,01
3,21
3,95
3,77 2,85
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CE NG IZ JE LJ TR MB PT MS BRE NM SG
DD
D /
/1
00
BO
D
J01MA02_P J01MA02_O
Paranteral vs oral use of ciprofloxacin in Slovenian hospitals 2013
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33
25 24 24 23 22 18 17 17 17
14
34
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Hosptial costs(EUR) for antibiotics - per admission in Slovenian hospital and UKC-LJ 2013
J01 J02
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Conclusion • Surveillance of antibiotic consumption in
Slovenia is compulsory
• Surveillance is at national ,hospital and department level
• The data are expressed in DDD/100 bed-days and DDD/100 admissions,POvs IV,costs
• ICM team audits hospitals with high total and high usage of CIA
• Future:correlation antibiotic use vs resistance case-mix,electronic prescriptions,split inpatients/outpatients etc