Disclosure slide. (potentiële) belangenverstrengeling. Geen

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1 BRMO

2 Disclosure slide (potentiële) belangenverstrengeling Voor bijeenkomst mogelijk relevante relaties met bedrijven Sponsoring of onderzoeksgeld Honorarium of andere (financiële) vergoeding Aandeelhouder Andere relatie, namelijk geen geen geen geen Geen Bedrijfsnamen

3 Inhoud Antibiotic resistance sept. 2014

4 Definitie BRMO BRMO penicilline resistente Streptococcus pneumoniae + penicilline resistente Staphylococcus aureus - methicilline resistente Staphylococcus epidermidis - methicilline resistente Staphylococcus aureus + co trimoxazole resistente Escherichia coli - co trimoxazole resistente Stenotrophomonas maltophilia +

5 Antibiotic resistance- what is known Is increasing Is a worldwide problem Size of the problem depends on the country the micro organism the antibiotic the availability of relevant data 5 Antibiotic resistance i

6 6 Antibiotic resistance

7 7 Antibiotic resistance

8 8 Antibiotic resistance

9 9 Antibiotic resistance in Europe

10 10 Antibiotic resistance in Europe

11 Antibiotic resistance- what is known Is increasing Is a worldwide problem Size of the problem depends on the country the micro organism the antibiotic the availability of relevant data 11 Antibiotic resistance i

12 Antibiotica resistentie - Ontstaan Mutatie: in DNA, gebeurt spontaan ook in afwezigheid van antibiotica, Selectie: verspreiding, onder invloed van antibiotica gebruik (= selectie druk)

13 Mechanismen van resistentie Verandering van aangrijpingspunt van het antibioticum in de bacterie: methcilline resistentie Productie van antibioticum- inactiverende enzymen: beta-lactamases: maken beta- lactam ring in beta-lactam antibiotica kapot, Efflux pompen: verandering van permeabiliteit: meer antbioticum eruit dan erin: quinolones

14 Resistentie - Genetische informatie Plasmid Chromosomaal Plasmid makkelijker verspreiding dan Chromosomaal Genetische informatie kan overspringen van plasmid naar chromosoom en omgekeerd Plasmid: deel van de bacterie vespreidt zich, kan tussen bacterie soorten worden uitgewisseld. Chromosoom: bacterie verspreidt zich

15 15 Antibiotic resistance in Europe

16 16 Antibiotic resistance in Europe

17 Antibiotic resistance Problem Antibiotic resistance: main risk factor Human Antibiotic Use animal use travelling abroad Antibiotic use world wide: 50% incorrect: indication, choice and duration 50% unavailable 17 Antibiotic resistance

18 Hawser Antibiotic resistance

19 19 Antibiotic resistance in Europe

20 20 Antibiotic resistance in Europe

21 21 Antibiotic resistance in Europe

22 22 Antibiotic resistance

23 Antibiotic resistance Problem Antibiotic resistance: main risk factor Human Antibiotic Use animal use travelling abroad Antibiotic use world wide: 50% incorrect: indication, choice and duration 50% unavailable 23 Antibiotic resistance

24 Optimal Antibiotic use Correct indication Correct choice Correct duration Correct administration 24 Antibiotic resistance

25 Patient-Hospital population * the patient population * specialism: ICU, gynaecology, surgery, haematology * in out patients: > or < 48 hours after admittance * in patients: only first isolate or during hospitalisation * infection or surveillance 25 Antibiotic resistance

26 Surveillance studies Tools should be developed to provide customer- specific datasets A. Dalhoff, Infection

27 Availability of relevant data Surveillance data: Many resistance surveillance studies suffer from inaccuracies like the sampling of a selected patiënt population hospitalized or after therapy failure the number of national participating centers (mostly limited to one or two participating) restricted geographical sampling undefined requirements of the user( infection control specialist,prescribing physician,microbologist) A. Dalhoff, Infection Antibiotic resistance in Europe

28 Surveillance studies Most surveillance studies suffer from well recognized but incorrect biases or inaccuracies BUT, they provide important information that allow the identification of trends in pathogen incidence and antimicrobial resistance A. Dalhoff, Infection Antibiotic resistance

29 Hawser Antibiotic resistance

30 Hawser Antibiotic resistance

31 International Surveillance Programs EARS-Net: ECDC, 28 European countries, Increasing resistance of invasive E. coli to all antibiotics Increase in MDR Klebsiella pneumoniae: third generation cephlalosporins: ceftazidime fluoroquinolones: ciprofloxacin aminoglycosides: gentamicin Resistance to Carbapenems: KPC, OXA-48, NDM 31 Antibiotic resistance

32 Nationaal surveillance programma ISIS AR Routine data van microbiologische laboratoria, ziekenhuispat. Streven is aansluiting van alle laboratoria Data o.a beschikbaar via NethMap,

33 33 Antibiotic resistance in Europe

34 34 Antibiotic resistance in Europe

35 35 Antibiotic resistance in Europe

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37 Surveillance studies Klinische isolaten: ziekenhuis laboratoria infecties Gram positieven: Staph. aureus en andere Gram negatieven: Enterobacteriaceae en andere Surveillance isolates: dragerschap Gram positieven: Staph. aureus - MRSA Gram negatieven: Escherichia coli 37 Antibiotic resistance

38 38 Antibiotic resistance

39 39 Antibiotic resistance in Europe

40 Prevalentie van MRSA bij huisartspatienten 40 Antibiotic resistance

41 41 Antibiotic resistance in Europe

42 42 Antibiotic resistance in Europe

43 Take home message Antibiotica resistentie neemt wereldwijd toe, ook in Nederland Resistentie is afhankelijk van micro organisme en van het antibioticum Antibiotica gebruik is belangrijke risicofactor voor resistentie Optimaal gebruik betekent juiste indicatie, keus, duur en toedieningsweg, Juiste keus: relevante surveillance data essentieel Voorkomen is beter dan genezen: An ounce of prevention is worth a pound of cure

44 Antibiotic resistance prevention What can WE do? 44 Antibiotic resistance in Europe

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46 46 Antibiotic resistance in Europe