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
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
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
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
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
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
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
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
Total use of antibiotics (DDD/100bed -days) according to the type of hospital 2013 - 2012
0
10
20
30
40
50
60
70
80
90
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Hospital use of cephalosporins in Slovenian hospitals 1997-2013 (DDD / 100 bed-days)
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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a
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r. Sob
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Bre
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NM
SGD
DD
/ 1
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AD
M
Cephalosporin 3. gen (J01DD)
Cephalosporin 1. gen (J01DB)
Cephalosporin 2. gen (J01DC)
Cephalosporin 4. gen (J01DE)
Hospital use of carbapenems in Slovenian hospitals 1997-2013 (DDD / 100 bed-days)
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
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
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
33
25 24 24 23 22 18 17 17 17
14
34
7
0
5
10
15
20
25
30
35
40U
KC
LJ
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SB S
B S
love
nj G
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SB N
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Go
rica
Hosptial costs(EUR) for antibiotics - per admission in Slovenian hospital and UKC-LJ 2013
J01 J02
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
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