1) Finland has comprehensive national surveillance of antimicrobial resistance (AMR) as required by law, participates in international surveillance systems, and updated its national action plan on AMR in 2017. 2) AMR surveillance is coordinated by the National Institute for Health and Welfare (THL) and involves all 23 clinical microbiology laboratories in Finland. Over 287,000 bacterial isolates are tested for AMR annually. 3) Finland reports antimicrobial consumption data to the European Surveillance of Antimicrobial Consumption Network and publishes an annual national report on antimicrobial consumption trends from 2011-2018.

1. 26.2.2020 1
Finnish national AMR monitoring
Jari Jalava, PhD

2. Surveillance of AMR in Finland
• Communicable Diseases Act (1227/2016) requires comprehensive surveillance of AMR.
• Surveillance at national level and developing indicators are mainly THL’s responsibility (also in
National Action Plan)
• Participation in international surveillance systems
• EARS-net (ECDC)
• other networks conducted ECDC/EFSA that collect AMR data
• GLASS (WHO)
26.2.2020 2

3. National action plan on AMR
26.2.2020 3
2000 2017
• Finland updated its plan on May 2017
• Ministry of Social Affairs and Health
• National Institute for Health and Welfare (THL)
• Ministry of Agriculture and Forestry
• Finnish Food Authority (Ruokavirasto)
• Several stakeholders
• http://urn.fi/URN:ISBN:978-952-00-3965-3

4. Organization of AMR Surveillance in Finland
4
• Finres:
• National antimicrobial susceptibility
database (THL)
• 19 clinically important
bacteria/antimicrobials
• Including MRSA, VRE, ESBL, (CPE)
• Infections
• 287 000 isolates / year
• 2 000 000 tests / year
• Coverage of blood cultures over 98%
• FiRe: (Finnish study group for
antimicrobial resistance)
• Network, since 1992
• Harmonization of susceptibility
testing and collection of data
• All clinical microbiology
laboratories (23)
• Including private laboratories
• THL mycobacterium laboratory
www.finres.fi
26.2.2020
NIDR: MDRs, PPS

5. 26.2.2020 5
1. Acinetobacter baumannii
2. Campylobacter coli
3. Campylobacter jejuni
4. Enterobacter cloacae
5. Enterococcus faecalis
6. Enterococcus faecium
7. Eschericia coli
8. Haemophilus influenzae
9. Klebsiella oxytoca
10. Klebsiella pneumoniae
11. Moraxella catarrhalis
12. Mycobacterium tuberculosis
13. nontuberculous mycobacteria
14. Neisseria gonorrhoeae
15. Pseudomonas aeruginosa
16. Salmonella enterica
17. Staphylococcus aureus
18. Streptococcus pneumoniae
19. Streptococcus pyogenes

6. Effica Samba Tamlab
WHONET (db)
Finres database
Infectious diseases register
Finres report
THL www interface
FiRe laboratories
EARS-Net
26.2.2020
Public www interface Data
Cube
THLwww-upload
GLASS
FWD, Campy
6
Whonet 2019
Excel

7. 26.2.2020 7
https://sampo.thl.fi/pivot/prod/fi/finres/lite/fact_lite

8. www.finres.fi
Finres reports
26.2.2020
2017
2015
2014
2013
2012
2016
2017
8
2018

9. 26.2.2020
Acinetobacter baumannii
Campylobacter coli
Campylobacter jejuni
Enterobacter cloacae
Enterococcus faecalis
Enterococcus faecium
Eschericia coli
Haemophilus influenzae
Klebsiella oxytoca
Klebsiella pneumoniae
Moraxella catarrhalis
Mycobacterium tuberculosis
nontuberculous mycobacteria
Neisseria gonorrhoeae
Pseudomonas aeruginosa
Salmonella enterica
Staphylococcus aureus
Streptococcus pneumoniae
Streptococcus pyogenes
9
http://ecdc.europa.eu/en/healthtopics/antimicrobial-resistance-and-
consumption/antimicrobial_resistance/EARS-Net/Pages/EARS-Net.aspx
EARS-Net

10. 26.2.2020
Acinetobacter baumannii
Campylobacter coli
Campylobacter jejuni
Enterobacter cloacae
Enterococcus faecalis
Enterococcus faecium
Eschericia coli
Haemophilus influenzae
Klebsiella oxytoca
Klebsiella pneumoniae
Moraxella catarrhalis
Mycobacterium tuberculosis
nontuberculous mycobacteria
Neisseria gonorrhoeae
Pseudomonas aeruginosa
Salmonella enterica
Staphylococcus aureus
Streptococcus pneumoniae
Streptococcus pyogenes
10
GLASS*
*Also other than invasive isolates

11. 26.2.2020 11
EFSA 2017
Campylobacter coli
Campylobacter jejuni

12. 26.2.2020 12
Gonococcal AMR survellance GASP 2017
Data from the HUSLAB and NIDR

13. 26.2.2020 13

14. Finnish Institute for Health and Welfare
Antimicrobial consumption in Finland
2011-2018
Jari Jalava, PhD
26.2.2020

15. ESAC-Net
European Surveillance of Antimicrobial Consumption Network
• Finland has participated since 1997
• Systemic antimicrobials (no topical products)
• Community and hospital sector reported separately
• Indicator: yearly number of DDD per 1000 inhabitants per
day
• Finnish data
• Number of packages per treatment per HD
• Three largest wholesalers ->
≃ 100 % of total medicine sales in Finland
4.3.2020 15

16. ESAC-Net data
• From different/ multiple sources
– NOT comparable between countries
4.3.2020 16
AC: community consumption
HC: hospital consumption
S: sales data
R: reimbursement data
B: both S & R

17. Antimicrobials under surveillance
26.2.2020

18. ESAC-Net database
https://ecdc.europa.eu/en/antimicrobial-consumption/surveillance-and-disease-data/database26.2.2020

19. 26.2.2020
https://ecdc.europa.eu/en/antimicrobial-consumption/surveillance-and-disease-data/database

20. Regional consumption in Finland
• Finnish data is available also by hospital district (N=20)
• Consumption per population (DDD/ day/ 1000 inhabitants)
• Consumption trends
• Average change per year
• Change according to a linear regression model
• Distribution of antimicrobial agents consumed
26.2.2020

21. National report published in November
26.2.2020http://urn.fi/URN:ISBN:978-952-343-425-7

22. Consumption of antibacterials (J01), Finland, 2011-2018
26.2.2020

23. 26.2.2020
Consumption of antibacterials (J01), Finland, 2011-2018

24. Consumption of specific antibacterials used for the treatment of
patients infected with multidrug-resistant bacteria
(J01CR05, J01DH, J01XB), Finland, 2011-2018
4.3.2020 24

25. Consumption of antibacterials (J01) by hospital district 2011-
2018
26.2.2020

26. Consumption of antibacterials (J01) by hospital district 2011-
2018
4.3.2020 26

27. Systemic antimycotics (J02, D01BA), Finland, 2011-2018
26.2.2020

28. 4.3.2020 28
Systemic antimycotics (J02, D01BA), Finland, 2011-2018

29. Future developing plans for AMC surveillance
• Annual national report in November (around EAAD)
• Finnish Institute for Health and Welfare
• Reporting hospital and community consumption separately
• Finnish Medicines Agency Fimea
• Better separation of hospital/community consumption
• Community consumption reporting population-based
• Hospital consumption reporting in relation to hospital-days
• Reporting AMC according to age groups – re-imbursement data utilization(?)
• Social Insurance Institution of Finland
26.2.2020

30. Acknowledgements
• Emmi Sarvikivi, MD, PhD, THL: antimicrobial consumption
26.2.2020

31. Finnish Institute for Health and Welfare
Antimicrobial consumption in Finland
2011-2018
Jari Jalava, PhD
26.2.2020

32. ESAC-Net
European Surveillance of Antimicrobial Consumption Network
• Finland has participated since 1997
• Systemic antimicrobials (no topical products)
• Community and hospital sector reported separately
• Indicator: yearly number of DDD per 1000
inhabitants per day
• Finnish data
• Number of packages per treatment per HD
• Three largest wholesalers ->
≃ 100 % of total medicine sales in Finland 4.3.2020 32

33. ESAC-Net data
• From different/ multiple sources
– NOT comparable between countries
4.3.2020 33
AC: community consumption
HC: hospital consumption
S: sales data
R: reimbursement data
B: both S & R

34. Antimicrobials under surveillance
26.2.2020

35. ESAC-Net database
https://ecdc.europa.eu/en/antimicrobial-consumption/surveillance-and-disease-data/database 26.2.2020

36. 26.2.2020https://ecdc.europa.eu/en/antimicrobial-consumption/surveillance-and-disease-data/database

37. Regional consumption in Finland
• Finnish data is available also by hospital district (N=20)
• Consumption per population (DDD/ day/ 1000 inhabitants)
• Consumption trends
• Average change per year
• Change according to a linear regression model
• Distribution of antimicrobial agents consumed
26.2.2020

38. National report published in November
26.2.2020http://urn.fi/URN:ISBN:978-952-343-425-7

39. Consumption of antibacterials (J01), Finland, 2011-2018
26.2.2020

40. 26.2.2020
Consumption of antibacterials (J01), Finland, 2011-2018

41. Consumption of specific antibacterials used for the treatment of
patients infected with multidrug-resistant bacteria
(J01CR05, J01DH, J01XB), Finland, 2011-2018
4.3.2020 41

42. Consumption of antibacterials (J01) by hospital district 2011-
2018
26.2.2020

43. Consumption of antibacterials (J01) by hospital district 2011-
2018
4.3.2020 43

44. Systemic antimycotics (J02, D01BA), Finland, 2011-2018
26.2.2020

45. 4.3.2020 45
Systemic antimycotics (J02, D01BA), Finland, 2011-2018

46. Future developing plans for AMC surveillance
• Annual national report in November (around EAAD)
• Finnish Institute for Health and Welfare
• Reporting hospital and community consumption separately
• Finnish Medicines Agency Fimea
• Better separation of hospital/community consumption
• Community consumption reporting population-based
• Hospital consumption reporting in relation to hospital-days
• Reporting AMC according to age groups – re-imbursement data utilization(?)
• Social Insurance Institution of Finland
26.2.2020

47. Acknowledgements
• Emmi Sarvikivi, MD, PhD, THL: antimicrobial consumption
26.2.2020