hospital id: 831 habib bourguiba hospital tertiary ...habib bourguiba university hospital, sfax,...
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Hospital ID: 831 Habib Bourguiba Hospital
Tertiary hospital 2017
Basma MNIF Associate professor
Laboratory of Microbiology
Habib Bourguiba University Hospital, Sfax, Tunisia
Tunisia Point Prevalence Survey Habib Bourguiba Hospital Tertiary hospital 2017
Global Point Prevalence Survey of Antimicrobial Consumption and Resistance in
hospitals worldwide
ASLM 2018
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Disclosures
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Outline
• Background
• Methods
• Results
• Targets and actions
• Conclusion
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Global-PPS : an innovative worldwide accessible web-based tool
• Standardized and simple approach
• Data collection on antibiotic prescription
patterns and resistance in the hospital
• Data comparison, nationally and worldwide
Identify targets to improve antibiotic prescribing
Combat antibiotic resistance
Continually improve healthcare quality
designed by the University of Antwerp, Belgium (www.global-pps.com)
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Participation to Global−PPS according to UN macro−geographical regions (2017)
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G-PPS Habib Bourguiba Hospital (HBH), Sfax, Tunisia
450 beds
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22
28
36
42 42 45
42
47 50
47 45 44
40
49 46 45
47 50
52
4 2
4 3 6 7 7
9 7 7
9 9 9 12
15 19
22 24
26
0
10
20
30
40
50
60
70
80
90
100
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
K. pneumoniae
E. coli
Evolution of third-generation cephalosporin resistance in Enterobacteriaceae in HB hospital
ESBL spread % R
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0 0 0 0 0 0 0 0 0 0 2,2
0,5 0,1 0 0,6 1,5
6
10
15 15
20
23 23
0
10
20
30
40
50
60
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
% imipenem resistance K. pneumoniae % R
SPREAD of NDM
Carbapenemase spread
Evolution of carbapenem resistance in Enterobacteriaceae in HB hospital
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6,8 4,5
20,5 17,5
13,1
7
24,3
37,7
50,2
56 53,5
51 50 51
71
76
72
81
86 88 87 88
18,3 18,9
24,2 22,1
17,5 18 17,4
24,5 23,3
36,5
23 23 25
28 26
23
32,3
24 27
21 20
0
10
20
30
40
50
60
70
80
90
100
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
A. baumannii
P. aeruginosa
% R
Années
Evolution of carbapenem resistance in non fermenter Gram-negative bacilli in HB hospital
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10
Poor hygiene Antibiotic misuse
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Methods • Global-PPS was carried out in Habib Bourguiba university
hospital in Tunisia between November and December 2017 • Protocol (www.global-PPS.com) • Data collection templates-paper forms : ward and patient
forms • All inpatients receiving an antimicrobial on the day of the
point prevalence survey were included • Informations collected :
– patients‘ demographics – antimicrobial agents – indications for treatment – quality indicators : Reason in note, Targeted treatment, use of
biomarkers, microbiological data and MDROs
• Web-based data-entry, verification, validation and reporting through the G-PPS program
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Antibiotic prevalence rates
127 among 320 hospitalized patients
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Type of indication
36%
45%
18%
1%
CAI
HAI
Prophylaxis
unknown
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Overall proportional antibiotic use (2017) other beta-lactams
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Proportional use of other beta−lactam antibacterials (2017)
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The main antimicrobials prescribed
39
36
22
10
24
21
13
10
4
5
4
8
4
1
0 5 10 15 20 25 30 35 40 45
Amoxicillin and enzyme inhibitor
C3G
Imipenem
Other Beta-lactam
Ciprofloxacin Levofloxacin
Metronidazole
Amikacin Gentamicin
Colistin
Tigecycline
Vancomycin
Macrolids
Others ATB
Fluconazole
Aciclovir
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Frequently used antibiotics for sepsis
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Frequently used antibiotics for pneumonia
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Frequently used antibiotics for surgical prophylaxis
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Duration of surgical prophylaxis
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Quality indicators of antibiotic use in HBH
Quality indicators %
Reason in notes
23,4 %
Stop/review date documented 8,3 %
Guidelines missing 78,1 %
Multiple antibiotics 48,8 %
Targeted treatment
22,0 %
Treatment based on biomarker data 74.4 % (CRP)
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Quality indicators of antibiotic use
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MDRO detected
• 8 ESBL-producing Enterobacteriaceae
• 2 Ceftazidim-resistant P. aeruginosa
• 10 Carbapenem-resistant non fermenter Gram-negative bacilli (A. baumannii and P. aeruginosa)
• MRSA, VRE : 0
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MDRO carriage prevalence
Digestive carriage of MDRO for all the hospitalized patients :
•48/190 = 25,26 % ESBL-carriers
• 8/190 = 4.2 % CPE-carriers
High antibiotic selective pressure
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Identified targets to improve quality of antimicrobial prescribing
• No local guidelines
• No notes in medical records
• Excessive use of broad-spectrum antibiotics
• Insufficient microbiological documentation of infection
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Actions :
• Result interpretation reports sent to all participating wards (feedback)
• Team : a representative person from each ward, infectious disease specialists, microbiologists and pharmacists
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Actions:
• Develop local guidelines
– Surgical prophylaxis
– Common HAI (sepsis, pneumonia, UTI)
• Education and practice changes
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Conclusions
•Need to raise awareness and encourage development of local antibiotic prescribing guidelines •Need for education and practice changes •Need to reduce the selective pressure of broad- spectrum antibiotics to control the dissemination of MDROs in the country •Repeated PPS : assess the effectiveness of actions
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Acknowledgments
• Laboratory of medical microbiology, vaccine and infectious diseases institute, university of Antwerp, Belgium
• All health workers who participated to the G-PPS
• Sponsor : BioMérieux, the sole sponsor of the G-PPS