strama - folkhalsomyndigheten.se · gunilla stridh ekman, strama uppsala län escherichia coli 61%...
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Gunilla Stridh Ekman, Strama Uppsala län
Strama
Ove AnderssonPrimary care physicianStrama Uppsala län
Gunilla Stridh Ekman, Strama Uppsala län
What is Strama?
Professional network
21 Strama groups
One group for each county
Gunilla Stridh Ekman, Strama Uppsala län
What is Strama?
Mission
- decrease in antibiotic resistance
- rational use of antibiotics
Purpose: To maintain the efficacy of antibiotics
Gunilla Stridh Ekman, Strama Uppsala län
www.lul.se/stramauppsala
Gunilla Stridh Ekman, Strama Uppsala län
Local Strama-group
• County medical officer
• General practitioner
• Infectious diseases
• Pharmacists
• Nurse
• Coordinator
The team
Local partners:
• Department ofinfectious diseases
• Department ofmicrobiology
• Department ofinfection control
• Municipality nurses
• County veterinary
• Childrens health care
• Local committee ofpharmaceuticals
• Primary care chiefphysician
• Hospital chiefphysicians
• Other hospital clinics
• National dental service agents
Gunilla Stridh Ekman, Strama Uppsala län
Primary health care
• Visit health care centers 2 times anually
• Feed-back prescription pattern
• National Recommendations
• Routines
• Local agents
• Information , campaigns towards thepublic
• Education
• Local resistance studies in primary care
• Pharmacist students studies
• Educational activities towards children health care, kindergartens, nursing homes
Gunilla Stridh Ekman, Strama Uppsala län
Hospitals
• Prescription feedback
• Information – doctors
• Education – doctors, nurses and assistantnurses
• Local antibiotic doctors
• Journal reviews
• Antibiotic stewardship
• Reviewing local treatment recommendations
Gunilla Stridh Ekman, Strama Uppsala län
Prescription satistics
• National database from pharmacies
• Prescribed and collected antibiotics
• Ordered antibiotics
• ”The tool of infections” -Infektionsverktyget
• Community acquired or health care associatedinfections or prophylactic treatment
• Electronic tool
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Swedres 2014 www.folkhalsomyndigheten.se
Antibiotic prescription in Sweden 2014
112016-08-19
Figure 1.24.
Prescription of narrow spectrum antibiotics in hospitals
Sweden 2014
122016-08-19
Figure 1.25.
* Includes all salens on requisition
Prescription of broad spectrum antibiotics in hospitals
Sweden 2014
Gunilla Stridh Ekman, Strama Uppsala län
Flouroquinolones and cephalosporins in hospitalsSweden 2013-2014
Källa: Strama Uppsala Län
Gunilla Stridh Ekman, Strama Uppsala län
Carbapenems in hospitals in Sweden 2013-2014
Källa: Strama Uppsala Län
Gunilla Stridh Ekman, Strama Uppsala län
Antibiotic prescription is decreasing in all 21 counties exceptin Uppsala
Källa: Strama Uppsala Län
Gunilla Stridh Ekman, Strama Uppsala län
Geriatric ward
Gunilla Stridh Ekman, Strama Uppsala län
Neurological ward
Gunilla Stridh Ekman, Strama Uppsala län
www.lul.se/stramauppsala
Gunilla Stridh Ekman, Strama Uppsala län
Gunilla Stridh Ekman, Strama Uppsala län
Strama Uppsala länUTI-screening 2016
Gunilla Stridh Ekman, Strama Uppsala län
Escherichia coli61%
Klebsiella pneumoniae3%
Proteus mirabilis2%
Staphylococcus saprophyticus
2%
Enterococcus faecalis2%
Staphylococcus aureus1%
Proteus vulgaris1%
grampositiv blandflora
18%
bakterier1%
Ingen växt av bakterier9%
Microbiologic findings Strama UTI-screening 2016( 176 cultures)
1 february - 3 march 2016
”bakterier”: flera olika sorters bakterier vilket beror på att provet inte tagits på rätt sätt, vanligen att man ej tagit mittstråleurin. Fynden ska inte antibiotikabehandlas.
Gunilla Stridh Ekman, Strama Uppsala län
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Ampicillin Cefadroxil Kinoloner(=Nal 2002-08)
Mecillinam Nitrofurantoin Trimetoprim
An
del
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Escherichia coli, antibiotikaresistens enligt Stramas UVI-screening inom primärvården i Uppsala län 2008 – 2016
2008 2009 2010 2011 2012 2013 2014 2015 2016
Gunilla Stridh Ekman, Strama Uppsala län2016: 8 st ESBL-A
0%
1%
2%
3%
4%
5%
6%
7%
8%
2008 2009 2010 2011 2012 2013 2014 2015 2016
An
del
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-bil
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eProportion ESBL-forming E. coli in Strama UTI-screening
All8 ESBL E. coli in 2016 screening were sensible towards pivmecillinam and nitrofurantoin