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Global Point Prevalence Survey of Antimicrobial Consumption and Resistance Presenter date Supporting healthcare professionals in the fight against resistance

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Expand the standardized antimicrobial web based PPS at a global scale to collect consistent, valid and comparable antimicrobial prescribing data. Monitor rates of antimicrobial prescribing in hospitalized adults, children and neonates. Determine the variation in drug, dose and indications of antimicrobial prescribing across continents. Identify targets to improve quality of antimicrobial prescribing. Help designing hospital interventions to promote prudent antimicrobial use. Assess effectiveness of interventions through repeated PPS. Increase public health capacity. AIMS Global-PPS 2

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Importent research questions What is the quantity and quality of antimicrobial prescribing? Geographical distribution and ranges Broad versus narrow spectrum antibiotic use Adults children - neonates Dose What are determinants of inappropriate antimicrobial prescribing ? Patient related : age, diagnosis, indication Institutional : hospital type, ward type, national/local policy, existing guidelines, . Geographical factors: region, country, cultural, availability of drugs on market, prescriber related (training), custum, . 3

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METHODOLOGY Global Point Prevalence Survey 4

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Organization at hospital level Creation of multidisciplinary team Allocation of local Global-PPS administrator Ethical approval Guarantee of data privacy Hospital names will never be revealed in any report or publication Complete anonymous patient data-entry Data are property of the respective hospital Publication policy available on request 5

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Departments concerned All wards (units/departments) of the hospital will be included once during February-April 2015. Data collection is done on a working day and never during a day of the weekend or bank holiday. Surgical departments are not to be surveyed on a Monday (or after a not-working day or bank holiday) to allow retrospective data collection on surgical prophylaxis. 6

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Wards pre-defined categorization 7 Adult departmentsPaediatric departments AMW (Adult Medical Ward)PMW (Paediatric Medical Ward) HO-AMW (Haematology-Oncology AMW)HO-PMW (Haematology-Oncology PMW) T-AMW (Transplant (BMT/solid) AMW)T-PMW (Transplant (BMT/Solid) PMW) P-AMW (Pneumology AMW) ASW (Adult Surgical Ward)PSW (Paediatric Surgical Ward) AICU ([Adult] Intensive Care Unit)PICU (Paediatric Intensive Care Unit) Neonatal departments NMW (Neonatal Medical Ward) NICU (Neonatal Intensive Care Unit)

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Global-PPS data collection, entry and management 1.Data collection on paper forms : Department (Ward) form (denominator data) Patient form (numerator data) 2.Web-based data-entry, verification, validation and reporting with the help of the Global-PPS programme. URL: http://app.globalpps.uantwerpen.be/globalpps_webpps/ 8

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Global-PPS data collection, entry and management 1.Data collection on paper forms : Department (Ward) form (denominator data) Patient form (numerator data) 2.Web-based data-entry, verification, validation and reporting with the help of the Global-PPS programme. URL: http://app.globalpps.uantwerpen.be/globalpps_webpps/ 9

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10 Description of ward : * Total of patients presents on the ward before 8 am and * Total beds on the ward at 8 am on the day of the survey.

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Patients Include all in-patients receiving an active/ongoing antimicrobial prescription at 8 am on the day of survey Numerator Inclusion criteria 11

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Antimicrobials under surveillance ( Antimicrobials under surveillance (according to WHO ATC classification) Antibacterials for systemic use: J01 Antimycotics and antifungals for systemic use: J02 and D01BA Antibiotics and other drugs used for treatment of tuberculosis: J04A Antibiotics used as intestinal anti-infectives: A07AA Antiprotozoals used as antibacterial agents, nitroimidazole derivatives: P01AB Antivirals used for influenza - Neuraminidase inhibitors: J05AH Antimalarials: P01B Antimicrobial for topical use are excluded ! 12 Definition of an antimicrobial agent Which one and when to include ? Prescribed at 8 am the day of the survey Include active and ongoing antimicrobials : include an ongoing antimicrobial prescribed e.g. 3 times/week but not on the day of the survey Numerator Inclusion criteria

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Day hopsitalizations and amulatory care patients Patients admitted on the ward after 8 am on the day of the survey Those patients are NOT counted in the numerator neither in the denominator! 13 Exclusion criteria : to be applied on the numerator and denominator

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Essential data to collect: numerator At the level of the patient: age, gender and weight At the level of the antimicrobial prescription: Antimicrobial agent/s (substance level - generic name) Dose per administration - N doses/day - route of administration Reasons for treatment (anatomical site of infection): what the clinician tends to treat Indication for therapy (Community Acquired or Health care Associated Infection; Medical or Surgical Prophylaxis) Reason of therapeutic or prophylactic prescription written in notes? Stop of review date prescription written in notes? Prescription compliant with local guidelines? Empiric versus Targeted treatment 14

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At the level of the antimicrobial prescription, next: Treatment based on biomarker; and which one (CRP, PCT or other lab-based biomarker) Microbiology data (if targeted treatment and one of the following): MRSA Methicillin-resistant coagulase-negative staphylococci VRE ESBL-producing Enterobacteriaceae 3 rd generation cephalosporin resistant Enterobacteriaceae non- ESBL producing or ESBL status unknown Carbapenem-resistant Enterobacteriaceae ESBL-producing nonfermenter Gram-negative bacilli Carbapenem-resistant non fermenter Gram-negative bacilli MDR organisms 15 Essential data to collect: numerator

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16 Ward Name/codeActivity (M, S, IC) Patient IdentifierSurvey NumberPatient Age v Weight In kg, 2 decimals Gender M or F Years (if 2 years) Months (1-23 month) Days (if

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17 Following anatomical site of infection Therapeutic Prophylactic Surgical Medical Neonates

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18 Community acquired Nosocomial Prophylaxis Surgical Medical Other CAI Community acquired infection Symptoms started 48 h post- admission or 1 day For surgical patients, administration of prophylactic antimicrobials should be checked in the previous 24 hours in order to encode the duration of prophylaxis as either one dose, one day (= multiple doses given within 24 hours) or >1 day. MP Medical prophylaxis For example long term use to prevent UTIs or use of antifungals in patients undergoing chemotherapy or penicillin in asplenic patients etc. OTH OtherFor example erythromycin as a motility agent (motilin agonist). UNKCompletely unknown indication Select 1 possibility for each reported antimicrobial APPENDIX III - Type of Indication

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Global-PPS data collection, entry and management 1.Data collection on paper forms : Department (Ward) form (denominator data) Patient form (numerator data) 2.Web-based data-entry, verification, validation and reporting with the help of the Global-PPS programme. URL: http://app.globalpps.uantwerpen.be/globalpps_webpps/ 19

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20 Web-Based Data Entry (English)

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21 Register each institution

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22 Each department need to have a unique name !

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Feedback of results 1.Extraction of own data containing raw data allowing verification and analysis of own hospital results (excel). 2.Generation of simple, easy to use feedback on own hospital data ready to use for local presentations. Descriptive statistics comparing your hospital with average national (if N3 institutions) and continental results. 28

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Examples: Antimicrobial prevalence rates Adult wards 29 Ward type All wardsAMWHO-AMWT-AMWP-AMWASWAICU Centre N patients N treated patients % treated patients Country N patients % treated patients Europe N patients % treated patients EU - type of centre N patients % treated patients Web-Based PPS Report

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Antimicrobial prevalence rates by activity CentreCountryEuropeEU type of centre Adults (>=18 year) Medical Surgical AICU Children (=