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. Project
AVS – Antibiotika-Verbrauchs-Surveillance
Birgitta Schweickert, Robert Koch-Institut,
Germany
1
ARHAI-Meeting, ECDC, 12.02.2015

2. Responsible institution: National public health institute, Robert Koch-Institute
2
Intent and purpose of the cooperation
• Establishment of a common technical platform, which facilitates the linking
of data from the different surveillance systems
• Use of allready existing technical infrastructures for data upload
The webbased electronic data portal „webKess“, a longstandig tool for the
submission of nosocomial infection data, has been extended for the upload of data
required for antibiotic consumption surveillance (interface between hospital and the
national public health institute)
Project background
National Reference Center for Surveillance of Nosocomial Infections
cooperation
ARHAI-Meeting, ECDC, 12.02.2015

3. 3
Aims of the project
• Support of the hospitals in establishment and conduct of antibiotic consumption
surveillance according to the legal requirements
• Efficient support of local antibiotic stewardship activities
• Collection of regionally and nationally representative data
• Provision of reference data
Perspective
Linkage of data from different surveillance systems
Project
ARHAI-Meeting, ECDC, 12.2.2015

4. Methods
4
ATC (Anatomical Therapeutic Chemical)/DDD (Defined daily
dose)-System of WHO
Target
measure
Number of daily doses (DDD) of a substance
100 patient days (PT) and admissions
Antiinfectives
J01 Antibiotics J05 Antivirals
J02 Antimycotics A07AA Intestinal antibiotics
J04A Antimycobacterials P01AB Nitroimidazol derivatives
Different medical specialties or single wards, respectively
Monthly, quaterly or yearly
Method
Organisation-
level
Time
interval
ARHAI-Meeting, ECDC, 12.02.2015

5. Data management
5

6. 6
Compilation of the transmitted data providing a clearly laid out overview in
order to facilitate a data check with respect to correctness, plausibility and
completeness of the data.
It primarily serves for internal quality control purposes.
- Standard report
- Ranking list
- Comparison reports (benchmarking)
1. Report on transmitted data
2. Feedback reports
Access: Webbased provision by password-protected access via an interactive data base
Reporting
Time frame: Provision of feedback reports within 24 hours after successful data upload
ARHAI-Meeting, ECDC, 12.02.2015

7. 7
Feedback reports
• The participant has the possibility to specify his/her data request
by selecting different parameters
- year(s) and time period for calculation
- organisational level (medical specialty/ward)
- ward type
- group of antiinfectives to be presented
- application form
- Basis of calculation
• Provision of different export formats (PDF, EXCEL,..)
Reporting
ARHAI-Meeting, ECDC, 12.02.2015

8. 8
Mask for the retrieval of feedback reports
Reporting
ARHAI-Meeting, ECDC, 12.02.2015

9. 9
Types of feedback reports
• Standard report
Presentation of the actual data in comparison to previous values in order to allow
for the assessment of the temporal development of the data.
• Ranking list
Presentation of the data according to consumption volume of the drugs (e.g. in
DDD) in descending order.
• Comparison reports
Presentation of individual hospital data in comparison to aggregated data of
reference hospitals (Median, mean, 25% und 75% Percentile).
Reporting
ARHAI-Meeting, ECDC, 12.02.2015

10. 10
Types of feedback reports
• Standard report
Presentation of the actual data in comparison to previous values in order to allow
for the assessment of the temporal development of the data.
• Ranking list
Presentation of the data according to consumption volume of the drugs (e.g. in
DDD) in descending order.
• Comparison reports
Presentation of individual hospital data in comparison to aggregated data of
reference hospitals (Median, mean, 25% und 75% Percentile).
Reporting
ARHAI-Meeting, ECDC, 12.02.2015

11. 11
Standard report: presentation of the temporal course of consumption data
Hospital X
Year(s): 2013; 2014 Time interval: yearly
Organisation level: Medical speciality Organisational unit: Surgery
Ward type: General ward Measure: DDD
Antiinfectives: Betalactam antibiotics, Pen Application form: entire
2013 2014
Wirkstoffgruppe DDD DDD/100 PD DDD/100 AD DDD DDD/100 PD DDD/100 AD
J01C-Beta-lactam-antibacterials, Penicillins 22,084 27.0 197.1 15,459 23.6 175.8
J01CA-Penicillins with extended spectrum 730 0.9 6.5 400 0.6 4.5
J01CA01-Ampicillin 370 0.5 3.3 120 0.2 1.4
J01CA04-Amoxicillin 360 0.4 3.2 280 0.4 3.2
J01CE-Beta-Lactamase-sensitive Penicillins 1,432 1.7 12.8 1,073 1.6 12.2
J01CE01-Benzylpenicillin 1,300 1.6 11.6 1,008 1.5 11.5
J01CE02-Phenoxymethylpenicillin 127 0.2 1.1 59 0.1 0.7
J01CE08-Benzylpenicillin-Benzathin 4 0.0 0.0 5 0.0 0.1
J01CF-Beta-Lactamase-resistent Penicillins 567 0.7 5.1 380 0.6 4.3
J01CF05-Flucloxacillin 567 0.7 5.1 380 0.6 4.3
J01CR-Combination of Penicillins, incl. Beta-
Lactamase-Inhibitors
19,356 23.7 172.7 13,607 20.8 154.8
J01CR01-Ampicillin and Enzym-Inhibitors 14,712 18.0 131.3 9,854 15.0 112.1
J01CR02-Amoxicillin and Enzym-Inhibitors 2,210 2.7 19.7 1,610 2.5 18.3
J01CR05-Piperacillin and Enzym-Inhibitors 2,434 3.0 21.7 2,143 3.3 24.4
Reporting

12. 12
Standard-report, graphical presentation
AVS – Reporting
ARHAI-Meeting, ECDC, 12.02.2015

13. 13
Types of feedback reports
• Standard report
Presentation of the actual data in comparison to previous values in order to allow
for the assessment of the temporal development of the data.
• Ranking list
Presentation of the data according to consumption volume of the drugs (e.g. in
DDD) in descending order.
• Comparison reports
Presentation of individual hospital data in comparison to aggregated data of
reference hospitals (Median, mean, 25% und 75% Percentile).
Reporting
ARHAI-Meeting, ECDC, 12.02.2015

14. 14
Ranking list
Hospital X
Year(s): 2013; 2014 Time interval: yearly
Organisation level: Medical speciality Organisational unit: all
Ward type: entire Measure: DDD
Antiinfectives: antibiotics Application form: entire
Antiinfective
2013 2012
Rank DDD % Rank DDD %
Gesamt 317,053 100.00 312,588 100.00
J01DC02-Cefuroxim 1. 68,135 21.49 1. 71,771 22.96
J01MA02-Ciprofloxacin 2. 21,874 6.90 2. 17,357 5.55
J01CR05-Piperacillin und Enzym-Inhibitoren 3. 20,398 6.43 3. 17,305 5.54
J01CR01-Ampicillin und Enzym-Inhibitoren 4. 16,425 5.18 4. 14,372 4.60
J02AC01-Fluconazol 5. 13,153 4.15 5. 13,525 4.33
J01EE01-Sulfamethoxazol und Trimethoprim 6. 12,071 3.81 8. 12,025 3.85
J01DH02-Meropenem 7. 11,985 3.78 9. 10,038 3.21
J01FA09-Clarithromycin 8. 10,590 3.34 6. 13,413 4.29
J01CE01-Benzylpenicillin 9. 10,166 3.21 13. 7,861 2.51
J01CA01-Ampicillin 10. 9,463 2.98 10. 9,410 3.01
J01DD04-Ceftriaxon 11. 9,365 2.95 7. 12,798 4.09
J01XD01-Metronidazol 12. 8,873 2.80 11. 9,040 2.89
J01CF05-Flucloxacillin 13. 7,946 2.51 18. 6,369 2.04
J01XA01-Vancomycin 14. 7,611 2.40 17. 6,422 2.05
J04AB02-Rifampicin 15. 7,074 2.23 16. 6,994 2.24
J01CA04-Amoxicillin 16. 6,860 2.16 14. 7,110 2.27
J01FF01-Clindamycin 17. 6,665 2.10 15. 7,017 2.24
J01MA12-Levofloxacin 18. 5,750 1.81 12. 8,404 2.69
J05AB01-Aciclovir 19. 4,073 1.28 19. 5,068 1.62
J02AC03-Voriconazol 20. 3,848 1.21 22. 3,854 1.23
J01DH51-Imipenem und Enzym-Inhibitoren 21. 3,351 1.06 20. 4,083 1.31
J02AA01-Amphotericin B 22. 2,655 0.84 26. 2,304 0.74
J01DD02-Ceftazidim 23. 2,635 0.83 21. 3,918 1.25
J01AA02-Doxycyclin 24. 2,395 0.76 24. 2,710 0.87
J04AC51-Isoniazid, Kombinationen 25. 2,350 0.74 23. 3,033 0.97
J05AB14-Valganciclovir 26. 2,340 0.74 31. 1,590 0.51
J01MA14-Moxifloxacin 27. 2,285 0.72 28. 2,138 0.68
J01FA01-Erythromycin 28. 2,130 0.67 25. 2,341 0.75
J01XX08-Linezolid 29. 1,875 0.59 29. 1,809 0.58
75%
90%
Reporting

15. 15
Types of feedback reports
• Standard report
Presentation of the actual data in comparison to previous values in order to allow
for the assessment of the temporal development of the data.
• Ranking list
Presentation of the data according to consumption volume of the drugs (e.g. in
DDD) in descending order.
• Comparison reports (benchmarking)
Presentation of individual hospital data in comparison to aggregated data of
reference hospitals (Median, mean, 25% und 75% Percentile).
Reporting
ARHAI-Meeting, ECDC, 12.02.2015

16. 16
Comparison report I, table form
*AC, antibiotic consumption
Reporting
Hospital X
Year: 2013 Organisational unit: Surgery
Organisational level: Medical speciality Time interval: yearly
Ward type: general ward Calculation: DDD
Antiinfectives: Penicillins with extended spectrum Application form: all
Reference hospitals
Hospital size: >400 Beds
Number of reference hospitals: 25
Level of care: Tertiary care
Medical department: surgical
Referenzdaten
Antiinfective AC*
hospital
Mean 25th Percentile Median 75th Percentile Range
DDD/
100 PD
DDD/
100 PD
DDD/100 PD
DDD/
100 PD
DDD/100 PD
DDD/
100 PD
J01CA
Penicillins with
extended Spectrum
67.4 26.3 48.1 87.6 67.4 26.3
J01CA01 Ampicillin (p) 22.2 4.6 15.1 29.3 22.2 4.6
J01CA01 Ampicillin (o) 0.2 0 0 0 0.2 0
J01CA04 Amoxicillin (p) 0.1 0 0 0 0.1 0
J01CA04 Amoxicillin (o) 11.7 1.8 7.4 18 11.7 1.8
J01CA10 Mezlocillin p) 4.1 0 0 0.4 4.1 0
J01CA12 Piperacillin (p) 29.2 0 4.4 37.3 29.2 0
ARHAI-Meeting, ECDC, 12.02.2015

17. 17
Comparison report I, graphical presentation
Reporting
ARHAI-Meeting, ECDC, 12.02.2015

18. 18
Comparison report II, graphical presentation
Reporting
ARHAI-Meeting, ECDC, 12.02.2015

19. 19
Webside
https://avs@rki.de
Contact: avs@rki.de
ARHAI-Meeting, ECDC, 12.02.2015

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ARHAI-Meeting, ECDC, 12.02.2015
Project schedule
• Pilotphase
Start in September 2014
Validation of the system with respect to content and technical aspects.
Result: functioning system, which allows transition to the routine phase
• Routinephase I
Since December 2014
Ongoing evaluation (questionnaire)
Current status
Registrations: 52 hospitals
10 hospitals allready passed the full cycle (data preparation and upload,
retrieval of feedback-reports)
• Routinephase II
Provision of reference data to the medical public

21. 21
Marcel Feig
Sebastian Kärsten
Tim Eckmanns
Muna Abu Sin
Hermann Claus
Doreen Richter
Hans-Peter Blank
Institute for Hygiene und
Environmental Medicine
Michael Behnke
Luis A. Pena Diaz
Philip Swarowsky
Petra Gastmeier
~
Department: Nosocomial infections,
Surveillance of antibiotic resistance and -consumption