THE PORTUGUESE NATIONAL PROGRAM FOR THE PREVENTION … · Sir Alexander Fleming Born: 6 August 1881...
44
THE PORTUGUESE NATIONAL PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE José Artur Paiva Director of Emergency and Intensive Care Department Hospital São João – Porto Associate Professor of Medicine University of Porto Infection and Sepsis I&D Group Coordinator for the National Program on Prevention of Antimicrobial Resistance Directorate National of Health- DGS Portugal
Transcript of THE PORTUGUESE NATIONAL PROGRAM FOR THE PREVENTION … · Sir Alexander Fleming Born: 6 August 1881...
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Joseacute Artur Paiva
Director of Emergency and Intensive Care Department
Hospital Satildeo Joatildeo ndash Porto
Associate Professor of Medicine
University of Porto
Infection and Sepsis IampD Group
Coordinator for the National Program on Prevention of Antimicrobial Resistance
Directorate National of Health- DGS
Portugal
Sir Alexander Fleming Born 6 August 1881
Deceased 11 March 1955
Discovery of penicillin from Penicillium notatum 1928
Nobel Prize 1945
Penicillin Man Alexander Fleming and the Antibiotic Revolution by Kevin Brown
RESISTANT MICRORGANISMS ndash HOW BIG IS THE PROBLEM THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Mean life expectancy in Portugal
0
10
20
30
40
50
60
70
80
90
1920 1940 1960 1980 2000
Mulher
Homem
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Idade
The XXth century The century of the antibiotic
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
1947 first report of penicillin
resistant strains
increasing resistance of
bacteria
gt 70 of bacteria causing HAI are
resistant ge1 antibiotic usually
used to treat them
Antimicrobial drug resistance in Europe
Europe 2005 Trends 2001ndash2005
Maximum (country)
Minimum (country) fdDagger
Increase (plt005)
Decrease (plt005)
PNSP 36 (FR) 13 (NL) 277 BG ES UK
FQRE 29 (PT) 3 (IS) 97 AT BE BG CZ DE ES FI HR HU LU NL PT
SE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESKAPE pathogens
bull Enterococcus vancomycin resistant
bull Staph aureus meticillin resistant
bull Klebsiella ESBL+
bull Acinetobacter IMIP-R
bull Pseudomonas aeruginosa IMIP-R
bull Enterobacter CEF-R
Rice J Infection 2008 197 1078-81
RESISTANT MICRORGANISMS ndash HOW BIG IS THE PROBLEM
Methicillin R Staphylococcus aureus EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Vancomycin R Enterococcus faecium
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Klebsiella pneumoniae ndash 3rd gen cephalosporin
EARSS 2008
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Sir Alexander Fleming Born 6 August 1881
Deceased 11 March 1955
Discovery of penicillin from Penicillium notatum 1928
Nobel Prize 1945
Penicillin Man Alexander Fleming and the Antibiotic Revolution by Kevin Brown
RESISTANT MICRORGANISMS ndash HOW BIG IS THE PROBLEM THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Mean life expectancy in Portugal
0
10
20
30
40
50
60
70
80
90
1920 1940 1960 1980 2000
Mulher
Homem
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Idade
The XXth century The century of the antibiotic
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
1947 first report of penicillin
resistant strains
increasing resistance of
bacteria
gt 70 of bacteria causing HAI are
resistant ge1 antibiotic usually
used to treat them
Antimicrobial drug resistance in Europe
Europe 2005 Trends 2001ndash2005
Maximum (country)
Minimum (country) fdDagger
Increase (plt005)
Decrease (plt005)
PNSP 36 (FR) 13 (NL) 277 BG ES UK
FQRE 29 (PT) 3 (IS) 97 AT BE BG CZ DE ES FI HR HU LU NL PT
SE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESKAPE pathogens
bull Enterococcus vancomycin resistant
bull Staph aureus meticillin resistant
bull Klebsiella ESBL+
bull Acinetobacter IMIP-R
bull Pseudomonas aeruginosa IMIP-R
bull Enterobacter CEF-R
Rice J Infection 2008 197 1078-81
RESISTANT MICRORGANISMS ndash HOW BIG IS THE PROBLEM
Methicillin R Staphylococcus aureus EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Vancomycin R Enterococcus faecium
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Klebsiella pneumoniae ndash 3rd gen cephalosporin
EARSS 2008
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Mean life expectancy in Portugal
0
10
20
30
40
50
60
70
80
90
1920 1940 1960 1980 2000
Mulher
Homem
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Idade
The XXth century The century of the antibiotic
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
1947 first report of penicillin
resistant strains
increasing resistance of
bacteria
gt 70 of bacteria causing HAI are
resistant ge1 antibiotic usually
used to treat them
Antimicrobial drug resistance in Europe
Europe 2005 Trends 2001ndash2005
Maximum (country)
Minimum (country) fdDagger
Increase (plt005)
Decrease (plt005)
PNSP 36 (FR) 13 (NL) 277 BG ES UK
FQRE 29 (PT) 3 (IS) 97 AT BE BG CZ DE ES FI HR HU LU NL PT
SE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESKAPE pathogens
bull Enterococcus vancomycin resistant
bull Staph aureus meticillin resistant
bull Klebsiella ESBL+
bull Acinetobacter IMIP-R
bull Pseudomonas aeruginosa IMIP-R
bull Enterobacter CEF-R
Rice J Infection 2008 197 1078-81
RESISTANT MICRORGANISMS ndash HOW BIG IS THE PROBLEM
Methicillin R Staphylococcus aureus EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Vancomycin R Enterococcus faecium
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Klebsiella pneumoniae ndash 3rd gen cephalosporin
EARSS 2008
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
The XXth century The century of the antibiotic
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
1947 first report of penicillin
resistant strains
increasing resistance of
bacteria
gt 70 of bacteria causing HAI are
resistant ge1 antibiotic usually
used to treat them
Antimicrobial drug resistance in Europe
Europe 2005 Trends 2001ndash2005
Maximum (country)
Minimum (country) fdDagger
Increase (plt005)
Decrease (plt005)
PNSP 36 (FR) 13 (NL) 277 BG ES UK
FQRE 29 (PT) 3 (IS) 97 AT BE BG CZ DE ES FI HR HU LU NL PT
SE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESKAPE pathogens
bull Enterococcus vancomycin resistant
bull Staph aureus meticillin resistant
bull Klebsiella ESBL+
bull Acinetobacter IMIP-R
bull Pseudomonas aeruginosa IMIP-R
bull Enterobacter CEF-R
Rice J Infection 2008 197 1078-81
RESISTANT MICRORGANISMS ndash HOW BIG IS THE PROBLEM
Methicillin R Staphylococcus aureus EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Vancomycin R Enterococcus faecium
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Klebsiella pneumoniae ndash 3rd gen cephalosporin
EARSS 2008
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Antimicrobial drug resistance in Europe
Europe 2005 Trends 2001ndash2005
Maximum (country)
Minimum (country) fdDagger
Increase (plt005)
Decrease (plt005)
PNSP 36 (FR) 13 (NL) 277 BG ES UK
FQRE 29 (PT) 3 (IS) 97 AT BE BG CZ DE ES FI HR HU LU NL PT
SE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESKAPE pathogens
bull Enterococcus vancomycin resistant
bull Staph aureus meticillin resistant
bull Klebsiella ESBL+
bull Acinetobacter IMIP-R
bull Pseudomonas aeruginosa IMIP-R
bull Enterobacter CEF-R
Rice J Infection 2008 197 1078-81
RESISTANT MICRORGANISMS ndash HOW BIG IS THE PROBLEM
Methicillin R Staphylococcus aureus EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Vancomycin R Enterococcus faecium
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Klebsiella pneumoniae ndash 3rd gen cephalosporin
EARSS 2008
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
ESKAPE pathogens
bull Enterococcus vancomycin resistant
bull Staph aureus meticillin resistant
bull Klebsiella ESBL+
bull Acinetobacter IMIP-R
bull Pseudomonas aeruginosa IMIP-R
bull Enterobacter CEF-R
Rice J Infection 2008 197 1078-81
RESISTANT MICRORGANISMS ndash HOW BIG IS THE PROBLEM
Methicillin R Staphylococcus aureus EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Vancomycin R Enterococcus faecium
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Klebsiella pneumoniae ndash 3rd gen cephalosporin
EARSS 2008
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Methicillin R Staphylococcus aureus EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Vancomycin R Enterococcus faecium
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Klebsiella pneumoniae ndash 3rd gen cephalosporin
EARSS 2008
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Vancomycin R Enterococcus faecium
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Klebsiella pneumoniae ndash 3rd gen cephalosporin
EARSS 2008
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Klebsiella pneumoniae ndash 3rd gen cephalosporin
EARSS 2008
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Quinolone resistant Escherichia coli
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Ano Resistecircncia
2001 18
2009 28
Portugal
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Carbapenem R Klebsiella pneumoniae
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Pseudomonas aeruginosa R to carbapenems
EARS-Net 2010
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Occurrence of fluoroquinolone-resistant Escherichia coli (FQRE)
plotted against outpatient use of fluoroquinolone antimicrobial agents
in 17 European
countries
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient Antibiotic
Consumption Trend in Europe
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Outpatient antibiotic use DDD 1000 habitants day
ESAC 2008
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Outpatient antibiotic consumption in Portugal
0
5
10
15
20
25
30
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
DDD
DDD
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
ESAC
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
We have a problem
A worldwide one
But at a high grade
No sustained improvement
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
bull Process indicator
to decrease antibiotic consumption
- quinolones by 10
- 3rd gen cephalosporins by 5
- carbapenems by 5
until 2015
bull Outcome indicator
to decrease antimicrobial resistance
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Surveillance systems bull Outpatient antimicrobial consumption surveillance system
bull Hospital antimicrobial consumption surveillance system
bull Veterinary medicine antimicrobial consumption surveillance
system
bull Antimicrobial resistance surveillance system
bull Antimicrobial resistance surveillance system for alert
microrganisms (quick response)
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Unfrequent pattern of resistance and that need immediate
infection control measures namely
bull VISA and VRSA
bull Staphylococcus aureus resistente to linezolide
bull Staphylococcus aureus and Enterococcus spp resistent to daptomicine
bull Enterococcus faecium and Enterococcus faecalis resistent to vancomycin
in health units with prevalence below 5
bull Enterobacteriaceae resistent to carbapenems or presumably
carbapenemase producers
bull Pseudomonas aeruginosa pan-resistent (PDR)
bull Pseudomonas aeruginosa extensive resistant(XDR) in health units with
prevalence below 5
bull Acinetobacter baumannii resistent to carbapenems in health units with
prevalence below 5
bull Acinetobacter baumannii PDR
Alert microrganisms
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
DeLisle S et al Chest 2003123504S-518S
Antibiotic Use and Infection Control
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Reduce antibiotic consumption
Education
Guidelines
Education Campaign
Role perception
Risk perception
Clinician
Regulation and Stewardship
Antimicrobial
Committees and Stewards
Citizen
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Guidelines
a General principles of antibiotic therapy b Treatment of urinary tract infections c Ampicillin e amoxicillin versus amoxicillinclavulanate d Surgical site infections prophylaxis e Carbapenems use f Quinolones use g Carbapenem resistant Enterobacteriaceae prevention and assessment h Treatment of comunity acquired pneumonia
PNPRA 2011-12
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Antibiotic Committees and Stwardship
bull Role and goals standardization
bull Empowerment
bull Extension to Primary Care and Continued Care
bull Easy access to and use of surveillance data
bull Education and Stewardship
bull Synergism between Antibiotic and Infection Control Committees
bull Close relationship with the DNH and the program head
THE PORTUGUESE NATIONAL PROGRAM FOR THE
PREVENTION OF ANTIMICROBIAL RESISTANCE
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Campaign for the Citizen ldquoPreserve the Antibioticsrdquo
From the 28th September 2011 to the 29th February 2012
GRUPO DE INFECCcedilAtildeO E SEacutePSIS
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
bull Increase societyrsquos awareness on the serious consequences of the inadequate use of antibiotics
bull Increase knowlwdge on microrganisms and antibiotics
bull Change attitudes and behavior
bull Avoid self-medication of antibiotics
bull Promote compliance to prescription
bull Promote rules on how to deal with spare pills
bull Involve doctors nurses phaarmaceuticals and citizens in the same goal and purpose
Campaign for the Citizen
Goals
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Campaign Supporting Partners
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
200 MUPIs placarded in the main cities
Campaign MUPIs
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
5000000 flyers and 10 000 posters
Campaign Flyers and Posters
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Campanha Spots
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
226
insertions
news
41 press
24 TV
20 radio
141 internet
Campaign Results
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Meeting people actions
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Antimicrobial use a broader problem
Agriculture 50
- Therapy 20
- Prophylaxis 80
- Highly questionable
40-80
Humans 50
- Hospital 20
- Community 80
- Highly questionable
20-50
- Innapropriate use
up to 50
THE PORTUGUESE PROGRAM FOR THE PREVENTION OF ANTIMICROBIAL RESISTANCE
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
bull Instituto Nacional de Sauacutede Dr Ricardo Jorge
bull Direcccedilatildeo Geral de Veterinaacuteria
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
bull DECO
bull Associaccedilatildeo Nacional de Farmaacutecias
bull Associaccedilatildeo Portuguesa de Induacutestria Farmacecircutica
bull Ordem dos Meacutedicos
bull Ordem dos Enfermeiros
bull Ordem dos Farmacecircuticos
bull Ordem dos Meacutedicos Veterinaacuterios
bull Associaccedilatildeo Portuguesa de Meacutedicos de Cliacutenica Geral
bull Administraccedilotildees Regionais de Sauacutede
bull Secretarias Regionais de Sauacutede
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
GRUPO DE INFECCcedilAtildeO ESEPSIS
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Portuguese Intersectorial Alliance for the Preservation of the Antibiotic
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
1 Recognition that the antibiotic is endangered and needs to be
protected as it is an unique medication producing potential
individual benefit but individual and colective risk
2 Eviction of self-medication promotion of compliance to medical
prescription and of the pharmacist role as a pedagogue in
antibiotic use
Alliance Memorandum
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Alliance Memorandum
3 Consolidation of the infection control activity and MDRMo cross
transmission prevention both in the community and in the hospital
namely promoting biosafety and vaccination in human and
veterinary medicine
4 Promotion of investigation on epidemiology and antimicrobial
resistance in human and veterinary sectors and of an easy access
of clinicians to data on antibiotic consumption and prevalence and
susceptibility of microrganisms
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Alliance Memorandum
5 Emanation and implementation of guidelines on the use of antibiotics
in human and veterinary medicine
6 Implementation of stuctures and processes of antibiotic stewardship
in all health units including primary and continued care as stated in
DGS 0282011 of 15072011
7 Development of the use of rapid microbiological tests that will permit
decrease the avoidable use of antibiotics
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
Alliance Memorandum
8 Implementation of rewardin policy for health units that attain good results decreasing antibiotic consumption and antimicrobial resistance
9 Promotion of a swift investigation development and marketing of new innovative and useful antibiotics
10 Promotion of the practices put forward by the European Platform for the Respondsible Use of Medication in Animals (EPRUMA)
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
3-4 Feb 2012
World Alliance Against Multiresistant Organisms
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
bull Direcccedilatildeo Geral de Inovaccedilatildeo e Desenvolvimento Curricular
Direcccedilatildeo Geral da Sauacutede
Grupo de Infecccedilatildeo e Sepsis
bull Children and adollescents as vector of a chain of andragogy
bull Enhance e-bug
Contest for the 2nd and 3rd cycle
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
bull High incidence of MR microrganisms
bull High level of antibiotic consumption
bull Vicious circle
bull Recognize the problem
and commit ourselves to solve it
bull Antimicrobial Resistance Prevention
and Infection Control
two faces of the same coin
Conclusions
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
bull Join efforts of different institutions
bull Join data to get a better picture
bull Donrsquot just take pictures
bull Create an effective chain of reaction
bull Led by a structure DNH-based
bull That leads helps facilitates and educates in close relation to local stewardship structures
bull Commit Regional Health Authorities
bull Create a system able to finantially reward the merit of improving results and attaining goals
bull Think broad Put the Alliance to work
To Do List in the near future
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
bull Armando Brito Saacute
bull Filipe Froes
bull Luiacutes Caldeira
bull Luiacutes Marques Lito
bull Luiacutesa Peixe
bull Mafalda Ribeirinho
bull Joseacute Artur Paiva
PNPRA Steering Group
