Hospital ID: 831 Habib Bourguiba Hospital Tertiary ...Habib Bourguiba University Hospital, Sfax, Tunisia Tunisia Point Prevalence Survey Habib Bourguiba Hospital Tertiary hospital

Hospital ID: 831 Habib Bourguiba Hospital

Tertiary hospital 2017

Basma MNIF Associate professor

Laboratory of Microbiology

Habib Bourguiba University Hospital, Sfax, Tunisia

Tunisia Point Prevalence Survey Habib Bourguiba Hospital Tertiary hospital 2017

Global Point Prevalence Survey of Antimicrobial Consumption and Resistance in

hospitals worldwide

ASLM 2018

Disclosures

Outline

• Background

• Methods

• Results

• Targets and actions

• Conclusion

Global-PPS : an innovative worldwide accessible web-based tool

• Standardized and simple approach

• Data collection on antibiotic prescription

patterns and resistance in the hospital

• Data comparison, nationally and worldwide

Identify targets to improve antibiotic prescribing

Combat antibiotic resistance

Continually improve healthcare quality

designed by the University of Antwerp, Belgium (www.global-pps.com)

Participation to Global−PPS according to UN macro−geographical regions (2017)

G-PPS Habib Bourguiba Hospital (HBH), Sfax, Tunisia

450 beds

22

28

36

42 42 45

42

47 50

47 45 44

40

49 46 45

47 50

52

4 2

4 3 6 7 7

9 7 7

9 9 9 12

15 19

22 24

26

0

10

20

30

40

50

60

70

80

90

100

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

K. pneumoniae

E. coli

Evolution of third-generation cephalosporin resistance in Enterobacteriaceae in HB hospital

ESBL spread % R

0 0 0 0 0 0 0 0 0 0 2,2

0,5 0,1 0 0,6 1,5

6

10

15 15

20

23 23

0

10

20

30

40

50

60

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% imipenem resistance K. pneumoniae % R

SPREAD of NDM

Carbapenemase spread

Evolution of carbapenem resistance in Enterobacteriaceae in HB hospital

6,8 4,5

20,5 17,5

13,1

7

24,3

37,7

50,2

56 53,5

51 50 51

71

76

72

81

86 88 87 88

18,3 18,9

24,2 22,1

17,5 18 17,4

24,5 23,3

36,5

23 23 25

28 26

23

32,3

24 27

21 20

0

10

20

30

40

50

60

70

80

90

100

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

A. baumannii

P. aeruginosa

% R

Années

Evolution of carbapenem resistance in non fermenter Gram-negative bacilli in HB hospital

10

Poor hygiene Antibiotic misuse

Methods • Global-PPS was carried out in Habib Bourguiba university

hospital in Tunisia between November and December 2017 • Protocol (www.global-PPS.com) • Data collection templates-paper forms : ward and patient

forms • All inpatients receiving an antimicrobial on the day of the

point prevalence survey were included • Informations collected :

– patients‘ demographics – antimicrobial agents – indications for treatment – quality indicators : Reason in note, Targeted treatment, use of

biomarkers, microbiological data and MDROs

• Web-based data-entry, verification, validation and reporting through the G-PPS program

Antibiotic prevalence rates

127 among 320 hospitalized patients

Type of indication

36%

45%

18%

1%

CAI

HAI

Prophylaxis

unknown

Overall proportional antibiotic use (2017) other beta-lactams

Proportional use of other beta−lactam antibacterials (2017)

The main antimicrobials prescribed

39

36

22

10

24

21

13

10

4

5

4

8

4

1

0 5 10 15 20 25 30 35 40 45

Amoxicillin and enzyme inhibitor

C3G

Imipenem

Other Beta-lactam

Ciprofloxacin Levofloxacin

Metronidazole

Amikacin Gentamicin

Colistin

Tigecycline

Vancomycin

Macrolids

Others ATB

Fluconazole

Aciclovir

Frequently used antibiotics for sepsis

Frequently used antibiotics for pneumonia

Frequently used antibiotics for surgical prophylaxis

Duration of surgical prophylaxis

Quality indicators of antibiotic use in HBH

Quality indicators %

Reason in notes

23,4 %

Stop/review date documented 8,3 %

Guidelines missing 78,1 %

Multiple antibiotics 48,8 %

Targeted treatment

22,0 %

Treatment based on biomarker data 74.4 % (CRP)

Quality indicators of antibiotic use

MDRO detected

• 8 ESBL-producing Enterobacteriaceae

• 2 Ceftazidim-resistant P. aeruginosa

• 10 Carbapenem-resistant non fermenter Gram-negative bacilli (A. baumannii and P. aeruginosa)

• MRSA, VRE : 0

MDRO carriage prevalence

Digestive carriage of MDRO for all the hospitalized patients :

•48/190 = 25,26 % ESBL-carriers

• 8/190 = 4.2 % CPE-carriers

High antibiotic selective pressure

Identified targets to improve quality of antimicrobial prescribing

• No local guidelines

• No notes in medical records

• Excessive use of broad-spectrum antibiotics

• Insufficient microbiological documentation of infection

Actions :

• Result interpretation reports sent to all participating wards (feedback)

• Team : a representative person from each ward, infectious disease specialists, microbiologists and pharmacists

Actions:

• Develop local guidelines

– Surgical prophylaxis

– Common HAI (sepsis, pneumonia, UTI)

• Education and practice changes

Conclusions

•Need to raise awareness and encourage development of local antibiotic prescribing guidelines •Need for education and practice changes •Need to reduce the selective pressure of broad- spectrum antibiotics to control the dissemination of MDROs in the country •Repeated PPS : assess the effectiveness of actions

Acknowledgments

• Laboratory of medical microbiology, vaccine and infectious diseases institute, university of Antwerp, Belgium

• All health workers who participated to the G-PPS

• Sponsor : BioMérieux, the sole sponsor of the G-PPS