Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015

1. Experiences from national – based
surveillance systems
Slovenia
Prof. Milan Čižman, MD
Head of ICM
Tom Bajec Data manager
Slovenian Surveillance AM
consumption team

2. Demographic data
• Slovenia is a small country with 2.061.623
inhabitants according to the 2014 census
• Almost all inhabitants (>99%) have compulsory
basic health insurance.
• No of hospitals 29
• No of hospital beds/1000 population in 2010:4.6
average EU 27: 5.3(2.7-8.3)
• Surveillance of antibiotic consumption in hospitals
-1985,1990,1995-national
• -UMC-Lj –hospital and depart. level since1998
• -ESAC- 2001, national
• -department- national consumption since 2006

3. Slovenia
Hospital Characteristics
Type of hospital Number of hospitals
Teaching 2
General 10
Special
- Psychiatric
- Maternity
- Rehabilitation
- Lung
- Oncology
- Ortopedic surgery
- Nursing
- Private
17
5
2
2
2
1
1
1
3

4. Annually tasks of consumption
surveillance team
• Annually update of national list of AM products
• Annually update of ATC and DDDs
• Source of data: hospital pharmacists
• In February each year the excel forms of all nationally available
antimicrobials are submitted to hospital pharmacists to fulfill (No of
packages, units) for total hospital and separately for 5 departments
• The request for annual No of bed-days and No of admissions is sent
to every hospital and NIPH
• The results of consumption using ATC/DDD methodology and
expressed in DDD/100bed-days and DDD/100 admissions are latter
available on the website
• Hospital pharmacist can compare their own data with the average
data of the same type of hospital or department

5. Surveillance of hospital antibiotic consumption in
Slovenia
Location: Ljubljana
Internet server Database server
ESACS
Database
Firewall
Internet
Location: Maribor
Hospital 1
Lokacija: Ljubljana
Hospital 2Hospital 3
Location
User x

6. Use of antibiotics (J01) in Slovenia 2008-2013
2008 2009 2010 2011 2012 2013
No of beds 9 587 9 389 9 367 9 493 9 349 9 377
No of
admissions
372 575 369 648 363 505 379 206 374 602 370 994
No of bed-
days
2 584 591 2 555 080 2 461 870 2 465262 2 446 111 2 439 895
Average
lenght of
stay
6.9 6.9 6.7 6.5 6.5 6.6
DDD/100
bed-days
48.25 50.95 52.26 50.43 47.88 47.65
DDD/100
admissions
342.28 365.33 356.38 327.88 312.64 313.36
DDD/TID 1.69 1.75 1.72 1.66 1.56 1.55
Source of data NIPH

7. Use of antibiotics (J01) in Slovenia 2008 vs 2013
2008 2013 ∆ % 2008 vs
2013
No of beds 9 587 9 377 - 2.2
No of admissions 372 575 370 994 - 0.5
No of bed-days 2 584 591 2 439 895 - 5.6
Average lenght of
stay
6.9 6.6 - 4.4
DDD/100 bed-days 48.25 47,65 - 1.3
DDD/100 admissions 342.28 313,36 - 8.5
DDD/TID 1.69 1.55 -8.3
Cost(EUR)
N=24
21 922 150 12 442 584 -43.3

8. Consumption (DDD/100 admissions) of antibiotics in Slovenia,
Denmark, Sweden and the Netherlands in 2011-2013
Country Hospitals 2011 2012 2013
Slovenia All 328 313 313
Slovenia university +
general
308 333 325
Denmark1 somatic 283 304 309
Sweden2 somatic, 273 279 265
The
Netherlands3
72/91hosp.
teaching +
general
306 296 NA
NA – not available, 1Danmap, 2Swedres, 3Nethmap

11. Total use of antibiotics (DDD/100bed -days) according to the type of hospital
2013 - 2012
0
10
20
30
40
50
60
70
80
90
UKCLJ
UKCMB
Celje
Šempeter
Izola
Jesenice
SBTrbovlje
Ptuj
MurskaSobota
Brežice
Novomesto
SlovenjGradec
Vojnik
Begunje
PsihLjubljana
PsihIdrija
Ormož
Topolščica
Golnik
Medicor
Bled
Kirurškisanatorij
Kranj
Postojna
Sežana
Valdoltra
Onkološki
Soča
CZBO
0
10
20
30
40
50
60
70
80
90
UKCLJ
UKCMB
Celje
Šempeter
Izola
Jesenice
SBTrbovlje
Ptuj
MurskaSobota
Brežice
Novomesto
SlovenjGradec
Vojnik
Begunje
PsihLjubljana
PsihIdrija
Ormož
Topolščica
Golnik
Medicor
Bled
Kirurškisanatorij
Kranj
Postojna
Sežana
Valdoltra
Onkološki
Soča
CZBO

12. Hospital use of cephalosporins in Slovenian hospitals 1997-2013
(DDD / 100 bed-days)

13. Consumption (DDD/100 adm) of cephalosporins in
Slovenian hospitals in 2013
0
20
40
60
80
100
120
140
160
180
200
Topol
Vojnik
Celje
Sežana
Šempeter
Izola
Medicor
Valdoltra
Begunje
Golnik
Bled
Jesenice
Kranj
UKCLJ
Onkološki
Postojna
Psih.Lj
Kir.Sana
Trbovlje
Soča
CZBO
Psih.Idrija
UKCMB
Ormož
Ptuj
Mur.Sob.
Brežice
NM
SG
DDD/100ADM
Cephalosporin 3. gen (J01DD)
Cephalosporin 1. gen (J01DB)
Cephalosporin 2. gen (J01DC)
Cephalosporin 4. gen (J01DE)

14. Hospital use of carbapenems in Slovenian hospitals 1997-2013
(DDD / 100 bed-days)

16. Consumption of antibiotics (DDD/100 bed-days) in different
deparments Slovenia 2013
0
50
100
150
200
250
300
350
MICU SICU MxICU Surgery Medicine Gynecology Paediatrics

17. 40,40
40,20 35,31
33,35
32,67
29,85
29,55 28,35 26,49
25,92
25,73 18,74
26,14
22,08 20,28
25,20
31,02
22,48
28,35 28,66 29,89
24,20
32,36 24,94
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LJ CE JES NM BRE MB IZ SG TRB PT MS NG
Consumption of antibiotics(DDD/100 bed-days) in University
and General hospitals in Slovenia 2013
O
P
I

18. 2,26 3,12
2,60
3,15
2,90
1,75
2,87
3,56
0,97
3,60
2,45
2,17
2,45 3,43
4,90
2,73
4,97
4,99
2,91
3,01
3,21
3,95
3,77
2,85
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CE NG IZ JE LJ TR MB PT MS BRE NM SG
DDD//100BOD
J01MA02_P J01MA02_O
Paranteral vs oral use of ciprofloxacin in Slovenian hospitals 2013

19. 33
25 24 24 23 22
18 17 17 17
14
34
7
0
5
10
15
20
25
30
35
40 UKCLJ
SBBrežice
SBTbovlje
SBJesenice
UKCMB
SBCelje
SBIzola
SBMurskaSobota
SBPtuj
SBSBSlovenjGradec
SBNovaGorica
Hosptial costs(EUR) for antibiotics - per admission in
Slovenian hospital and UKC-LJ 2013
J01 J02

20. Conclusion
• Surveillance of antibiotic consumption in
Slovenia is compulsory
• Surveillance is at national ,hospital and
department level
• The data are expressed in DDD/100 bed-days
and DDD/100 admissions,POvs IV,costs
• ICM team audits hospitals with high total and
high usage of CIA
• Future:correlation antibiotic use vs resistance
case-mix,electronic prescriptions,split
inpatients/outpatients etc