Outi Lyytikäinen, THL: Surveillance of antimicrobial consumption

1. SURVEILLANCE OF
ANTIMICROBIAL
CONSUMPTION IN FINLAND
Outi Lyytikäinen, research professor
Finnish Hospital Infection Program (SIRO)
Department of Health Security
National Institute for Health and Welfare (THL)

2. CONTROLLING AMR
 National action plan on AMR
– Ministry of Social Affairs and Health, 2017
– Tasks for National Institute for Health and
Welfare (THL)
 Developing surveillance and surveillance
indicators
– Antimicrobial resistance
– Antimicrobial consumption
– Healthcare-associated infections (HAI)
 Controlling spread and prevention of infections
– Outbreak investigations
– Guidelines
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3. NATIONAL EXPERT GROUP FOR AMR CONTROL
 Set up and chaired by THL (2018–2020)
 Tasks are to plan and follow up the implementation of the national plan as well as to
discuss current topics related to AMR which come up nationally or internationally.
 Members (One health -approach):
– Ministries: Social Affairs and Health (STM), Agriculture and Forestry (MMM) and
Environment (YM)
– THL, Finnish Medicines Agency (FIMEA), Agency of Reimbursement for
Medicine Expense (KELA), Finnish Food Authority, Zoonotic Center
– Experts: clinical microbiology laboratories, universities, infectious disease
physicians, infection control nurses
– Representatives: healthcare centers (general practitioners), specialty care, long-
term care, university and central hospitals
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4. SURVEILLANCE OF ANTIMICROBIAL
CONSUMPTION IN FINLAND
 Surveillance has been conducted since 1997 in collaboration
with Finnish Medicines Agency (Fimea)
 Participation in ESAC-NET surveillance organized by ECDC
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5. ESAC-NET
EUROPEAN SURVEILLANCE OF
ANTIMICROBIAL CONSUMPTION NETWORK
 Data on sales/purchase and/or reimbursement/prescription
 Systemic antimicrobials by Anatomical Therapeutic
Chemical (ATC) index
 Defined daily doses (DDDs)/1000 inhabitants/day
 Hospital and/or community sector
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6. ESAC-NET DATA COLLECTION
AC: community
HC: hospitals
S: sales data
R: reimbursement
B: both
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7. ESAC-NET DATABASE
https://ecdc.europa.eu/en/antimicrobial-consumption/surveillance-and-disease-data/database
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8. ESAC-NET INTERACTIVE DATABASE
Selection possibilities
• Year or time period
• Community or hospital sector or both
• All antimicrobials or ATC group or ATC subgroup
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9. ESAC-NET ANNUAL REPORTS
87 %
13 %13 June 2019 Antimicrobial consumption 9

10. ATC-GROUPS IN ESAC-NET SURVEILLANCE
1. Antibacterials (J01):
– Tetrasykliinit (J01A)
– Beetalaktaamirakenteiset bakteerilääkkeet,
penisilliinit (J01C)
– Muut beetalaktaamirakenteiset bakteerilääkkeet
(J01D)
– Sulfonamidit ja trimetopriimivalmisteet (J01E)
– Makrolidit, linkosamidit ja streptogramiinit
(J01F)
– Kinoliinijohdokset (Kinolonit) (J01M)
– Muut ryhmän J01 lääkkeet
2. Antifungals (J02, D01BA):
– Amfoterisiini (J02AA01)
– Ketokonatsoli (J02AB02)
– Flukonatsoli (J02AC01)
– Itrakonatsoli (J02AC02)
– Vorikonatsoli (J02AC03)
– Muut ryhmän J02 lääkkeet
– Terbinafiini (D01BA02)
– Muut ryhmän D01BA lääkkeet
3. Antimicrobials used in treatment of
infections caused by MDR microbes:
– Karbapeneemit (J01DH)
– Polymyksiinit (J01XB)
– Piperasilliini ja beetalaktamaasin estäjä
(J01CR05)
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11. THE FIRST FINNISH ANNUAL REPORT, 2017
INCLUDING REGIONAL REPORTS BY HEALTHCARE DISTRICTS
 Difficulties in separating hospital and community sector: hospital
sector includes healthcare center wards (post-acute care, non-
specialty care, rehabilitation and also long-term care)
 Summary by ATC groups
– The whole country/Finland
– Healthcare districts
 Published in November 2018 (18.11. EAAD)
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12. SYSTEMIC ANTIBACTERIALS (J01), FINLAND,
2010-2017
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13. SYSTEMIC ANTIBACTERIALS (J01), FINLAND,
2010-2017
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14. SYSTEMIC ANTIBACTERIALS (J01) BY
HEALTHCARE DISTRICTS, 2010-2017
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15. SYSTEMIC ANTIBACTERIALS, 2017
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16. SYSTEMIC ANTIFUNGALS (J02, D01BA),
FINLAND, 2010-2017
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17. SYSTEMIC ANTIFUNGALS (J02, D01BA),
FINLAND, 2010-2017
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18. SYSTEMIC ANTIFUNGALS (J02, D01BA) BY
HEALTHCARE DISTRICTS, 2010-2017
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19. SYSTEMIC ANTIFUNGALS, 2017
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20. ANTIMICROBIALS USED IN TREATMENT OF INFECTIONS
CAUSED BY MDR MICROBES (J01CR05, J01DH, J01XB),
FINLAND, 2010-2017
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21. ANTIMICROBIALS USED IN TREATMENT OF INFECTIONS
CAUSED BY MDR MICROBES (J01CR05, J01DH, J01XB) BY
HEALTHCARE DISTRICTS, 2010-2017
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22. ANTIMICROBIALS USED IN TREATMENT OF INFECTIONS
CAUSED BY MDR MICROBES (J01CR05, J01DH, J01XB),
2017
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23. PREVALENCE OF ANTIMICROBIAL USE
IN FINNISH ACUTE CARE HOSPITALS, 2016
(ECDC-PPS 2016-2017)
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24. Prevalence of antimicrobial use (AU)
2011 vs. 2016
40.5 (37.4-43.7) vs. 38.4%
AU parenteral 63.2 vs. 68.5%
AU reason in notes 80.0 vs. 81.1%
AU% by specialty
ICU 57.6 vs. 56.1
Surgery 49.0 vs. 49.4
Medicine 50.4 vs. 46.2
Pediatrics 30.2 vs. 24.5
Gyn/obst. 9.3 vs. 17.2
Geriatrics 43.5 vs. 16.7
Psychiatrics 4.1 vs. 2.7
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25. AU prevalence 2011 vs. 2016
40.5 (37.4-43.7) vs. 38.4%
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27. SURVEILLANCE OF ANTIMICROBIAL CONSUMPTION
 Total consumption of antimicrobials has constantly
decreased, especially in children outside hospitals
– Wide-spectrum antimicrobials are used more compared to other
Nordic countries and the Netherlands
– Regional differences in consumption
– Gaps and problems in usage of surveillance data in action
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28. FURTHER DEVELOPMENT
 Surveillance only based on wholesales data to pharmacies in the
community and healthcare facilities
 Improve separating hospital and community sector
– Population-based consumption in the community
– Hospital consumption per patient-days
 Prescription data by age and gender (KELA), so far only used in
research studies
– Surveillance
 Data on indications
– Drug list in the National Care Register (AvoHilmo)
– Electronic prescriptions
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