Informe sobre la situación del uso de antimicrobianos en España

Hospital Antimicrobial Use

and Resistances.Point Prevalence Surveys

(EPINE)

� EPINE

� Scope

� representativeness

� Antimicrobial use

� Selected antimicrobial-microorganism

resistances

� Summary

� EPINE: a series of Point Prevalence Surveys

� Anual: since 1990

� National study

� Non compulsory� Representativeness:

� (more than half acute care inpatients)

� Monitoring antimicrobial resistance since 1999� 2012: udpdated ECDC methodology

� Includes data on Community-onset infections

Year of the survey

123

135

163171

186

201206

214

224233

243 243 246241

258 257253

266

276 278287 287

271282

269277

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

100

150

200

250

300

Number of hospitals

Year of the survey

38,5

42,2

44,3

46,9

49,7

51,351,9 51,7

53,7 53,7

55,356,3

54,8 54,8 54,8

57,457,9

61,562,5

62 61,861,2

53,9

56,755,7

57,2

35

40

45

50

55

60

65

# of patients (thousands)

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Size of the Size of the

hospital hospital

Hospitals Hospitals Patients Patients

N N % % N N % %

≤200 beds 126 45,49 10.170 17,79

201 to 500 beds 81 29,24 17.430 30,48

>500 beds 49 17,69 25.937 45,36

Total 277 100,00 57.183 100,00

SAUR (O/E): 1.33 (95%CI 1.18-1.50; P 91)

01

23

4

SA

UR

(O

/E)

- E

U

Standardized AU ratio (SAUR), based on patient risk factors (standard risk adjustment)

Prevalence of antimicrobial use%

Year of the survey

Tendencia p<0,0001

33,8 34,5 34,9 34,4 34,635,6 36,1 35,8

36,7 3636,8 37,1 37

38,739,7 39,5

40,7 40,241,6

42,4 41,9

45,7 45,7 45,4 46,1

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

0

8

16

24

32

40

48

ECDC-PPS

Asensio A, et al. (EPINE WG). Trends in yearly prevalence of third-generation

cephalosporin and fluoroquinolone resistant Enterobacteriaceae infections and antimicrobial use in Spanish

hospitals, Spain, 1999 to 2010. Euro Surveill. 2011;16:36-9

Asensio A, et al. (EPINE WG). Trends in yearly prevalence of third-generation

cephalosporin and fluoroquinolone resistant Enterobacteriaceae infections and antimicrobial use in Spanish hospitals, Spain, 1999 to 2010. Euro Surveill. 2011;16:36-9

EPINE PPS 2012-2015

13,3

7,3

5,3

9,8

2,22,7

13,2

6,7

5

9,7

2,22,7

13,2

6,8

5

10,2

2,3

2,9

13,1

6,5

5,1

10,4

2,3

3

Pen+pen inhib.3-4G cephalosp

CarbapenemsQuinolones

Gly copeptidesAntimy cotics

0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16Prevalence of use (%)

2012 2013 2014 2015

[0,10](10,20](20,40](40,60](60,100]<10 isolates/not incl.

MRSA%(% of S. aureus)

43%

EPINE PPS 1993-2015

2219 18

25 25

29

40

36 37

45

41

4542

44

48 4851

43 43 4340

35

41

19931994

19951996

19971998

19992000

20012002

20032004

20052006

20072008

20092010

20112012

20132014

2015

0

5

10

15

20

25

30

35

40

45

50

55

60Proportion of resistance (%) ECDC-PPS

EPINE PPS 1993-2015

National Hand

Hygiene campaign

EPINE PPS 2012-2015

24 23 22

4340

35

41

36

3028

33

2012 2013 2014 2015

0

10

20

30

40

50

60Proportion of resistance (%)

Surgical Respiratory

Blood other

All EARSS

EPINE PPS 2012-2015

43

40

35

41

3331 32

38

2012 2013 2014 2015

0

5

10

15

20

25

30

35

40

45


Community

EARSS

Hospital

EPINE PPS 2012-2015

4

5

3

66

8

3

8

1

3

2 2

3

2 2 2

2012 2013 2014 2015

0

1

2

3

4

5

6

7

8

9


E. faecium EARSS E. faecalis Hosp

E. faecalis Com E. faecium Hosp

E. faecium Com

EPINE PPS 2012-2015

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

0

5

10

15

20

25

30

35

40

45


3GC/Escher. coli Carb/Escher. coli

3GC/K. pneumoniae Carbapenem/K. pneumoniae

3GC/Enterobacter spp Carb/Enterobacter spp

EPINE PPS 2012-2015

1413

12

19

1314

20

22

2019 19

2012 2013 2014 2015

0

5

10

15

20


Hospital

Community

EARS

EPINE PPS 2012-2015

1720

1821 20

25

33

38

4244

38

2012 2013 2014 2015

0

5

10

15

20

25

30

35

40

45


Hospital

Community

EARS

EPINE PPS 2012-2015

0,8 1,22,3

1213

17

12

2

4

6 6

2012 2013 2014 2015

0

2

4

6

8

10

12

14

16

18


Community

Hospital

EARS

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

0

10

20

30

40

50

60

70

80

90


Carb/P. aeruginosa

Carb/A. baumanii

EPINE PPS 1999-2015

ECDC-PPS

EPINE PPS 2012-2015

16,4 17,6 18,520 21 2123

29

37

3234

2012 2013 2014 2015

0

5

10

15

20

25

30

35

40

45


Hospital Community P. aeruginosa EARSS

EPINE PPS 2012-2015

68

4338

26

74

63 64 62

2012 2013 2014 2015

0

10

20

30

40

50

60

70

80

90


Hospital Community EARS

� Antimicrobial use is among the highest in Europe:

� For carbapenems, 3-4G cephalosporins, quinolones and antimycotics

� Former intensive use of quinolones and 3G cephalosporins

� Increase resistance of enterobacteriaceae to Quinolones and 3GC

� Intensive use of carbapenems

� increase resistance of enterobacteriaceae to carbapenems

� Rates of resistance

� MRSA:

▪ Is high

▪ Decreasing since 2010 associated to Hand Hygiene campaign

▪ Much higher than that reported by EARSS laboratories

▪ Resistance in the community is increasing toward hospital levels

� Enterobacteriaceae resistances

� E. coli and K pneumoniae 3GC resistance:

▪ high

▪ Community infections: reaching HAI levels

� E. coli resistant to Carbapenem: 1-2% of the HAIs

� K. pneumoniae resistant to carbapenems

▪ High: 12-17% of HAI isolates

▪ Community-onset infections: increasing: 2-6% in 2015

� Non fermenting GN bacilli resistance

� P. aeruginosa resitance to carbapenems is high and increasing in the

last 4 years

� A. baumanii resistant to carbapenem is high but decreasing.

� Rates of resistance reported by PPS are higher than thosereported by EARSS net

Hospital Antimicrobial use

and Resistance.Point Prevalence Surveys

(EPINE)

Informe sobre la situación del uso de antimicrobianos en España

Health & Medicine

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