Global Point Prevalence Survey of Antimicrobial Consumption and Resistance Presenter date Supporting...
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Global Point Prevalence Survey of Antimicrobial Consumption and Resistance Presenter date Supporting healthcare professionals in the fight against resistance
Global Point Prevalence Survey of Antimicrobial Consumption and
Resistance Presenter date Supporting healthcare professionals in
the fight against resistance
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Expand the standardized antimicrobial web based PPS at a global
scale to collect consistent, valid and comparable antimicrobial
prescribing data. Monitor rates of antimicrobial prescribing in
hospitalized adults, children and neonates. Determine the variation
in drug, dose and indications of antimicrobial prescribing across
continents. Identify targets to improve quality of antimicrobial
prescribing. Help designing hospital interventions to promote
prudent antimicrobial use. Assess effectiveness of interventions
through repeated PPS. Increase public health capacity. AIMS
Global-PPS 2
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Importent research questions What is the quantity and quality
of antimicrobial prescribing? Geographical distribution and ranges
Broad versus narrow spectrum antibiotic use Adults children -
neonates Dose What are determinants of inappropriate antimicrobial
prescribing ? Patient related : age, diagnosis, indication
Institutional : hospital type, ward type, national/local policy,
existing guidelines, . Geographical factors: region, country,
cultural, availability of drugs on market, prescriber related
(training), custum, . 3
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METHODOLOGY Global Point Prevalence Survey 4
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Organization at hospital level Creation of multidisciplinary
team Allocation of local Global-PPS administrator Ethical approval
Guarantee of data privacy Hospital names will never be revealed in
any report or publication Complete anonymous patient data-entry
Data are property of the respective hospital Publication policy
available on request 5
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Departments concerned All wards (units/departments) of the
hospital will be included once during February-April 2015. Data
collection is done on a working day and never during a day of the
weekend or bank holiday. Surgical departments are not to be
surveyed on a Monday (or after a not-working day or bank holiday)
to allow retrospective data collection on surgical prophylaxis.
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Wards pre-defined categorization 7 Adult departmentsPaediatric
departments AMW (Adult Medical Ward)PMW (Paediatric Medical Ward)
HO-AMW (Haematology-Oncology AMW)HO-PMW (Haematology-Oncology PMW)
T-AMW (Transplant (BMT/solid) AMW)T-PMW (Transplant (BMT/Solid)
PMW) P-AMW (Pneumology AMW) ASW (Adult Surgical Ward)PSW
(Paediatric Surgical Ward) AICU ([Adult] Intensive Care Unit)PICU
(Paediatric Intensive Care Unit) Neonatal departments NMW (Neonatal
Medical Ward) NICU (Neonatal Intensive Care Unit)
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Global-PPS data collection, entry and management 1.Data
collection on paper forms : Department (Ward) form (denominator
data) Patient form (numerator data) 2.Web-based data-entry,
verification, validation and reporting with the help of the
Global-PPS programme. URL:
http://app.globalpps.uantwerpen.be/globalpps_webpps/ 8
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Global-PPS data collection, entry and management 1.Data
collection on paper forms : Department (Ward) form (denominator
data) Patient form (numerator data) 2.Web-based data-entry,
verification, validation and reporting with the help of the
Global-PPS programme. URL:
http://app.globalpps.uantwerpen.be/globalpps_webpps/ 9
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10 Description of ward : * Total of patients presents on the
ward before 8 am and * Total beds on the ward at 8 am on the day of
the survey.
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Patients Include all in-patients receiving an active/ongoing
antimicrobial prescription at 8 am on the day of survey Numerator
Inclusion criteria 11
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Antimicrobials under surveillance ( Antimicrobials under
surveillance (according to WHO ATC classification) Antibacterials
for systemic use: J01 Antimycotics and antifungals for systemic
use: J02 and D01BA Antibiotics and other drugs used for treatment
of tuberculosis: J04A Antibiotics used as intestinal
anti-infectives: A07AA Antiprotozoals used as antibacterial agents,
nitroimidazole derivatives: P01AB Antivirals used for influenza -
Neuraminidase inhibitors: J05AH Antimalarials: P01B Antimicrobial
for topical use are excluded ! 12 Definition of an antimicrobial
agent Which one and when to include ? Prescribed at 8 am the day of
the survey Include active and ongoing antimicrobials : include an
ongoing antimicrobial prescribed e.g. 3 times/week but not on the
day of the survey Numerator Inclusion criteria
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Day hopsitalizations and amulatory care patients Patients
admitted on the ward after 8 am on the day of the survey Those
patients are NOT counted in the numerator neither in the
denominator! 13 Exclusion criteria : to be applied on the numerator
and denominator
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Essential data to collect: numerator At the level of the
patient: age, gender and weight At the level of the antimicrobial
prescription: Antimicrobial agent/s (substance level - generic
name) Dose per administration - N doses/day - route of
administration Reasons for treatment (anatomical site of
infection): what the clinician tends to treat Indication for
therapy (Community Acquired or Health care Associated Infection;
Medical or Surgical Prophylaxis) Reason of therapeutic or
prophylactic prescription written in notes? Stop of review date
prescription written in notes? Prescription compliant with local
guidelines? Empiric versus Targeted treatment 14
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At the level of the antimicrobial prescription, next: Treatment
based on biomarker; and which one (CRP, PCT or other lab-based
biomarker) Microbiology data (if targeted treatment and one of the
following): MRSA Methicillin-resistant coagulase-negative
staphylococci VRE ESBL-producing Enterobacteriaceae 3 rd generation
cephalosporin resistant Enterobacteriaceae non- ESBL producing or
ESBL status unknown Carbapenem-resistant Enterobacteriaceae
ESBL-producing nonfermenter Gram-negative bacilli
Carbapenem-resistant non fermenter Gram-negative bacilli MDR
organisms 15 Essential data to collect: numerator
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16 Ward Name/codeActivity (M, S, IC) Patient IdentifierSurvey
NumberPatient Age v Weight In kg, 2 decimals Gender M or F Years
(if 2 years) Months (1-23 month) Days (if
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17 Following anatomical site of infection Therapeutic
Prophylactic Surgical Medical Neonates
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18 Community acquired Nosocomial Prophylaxis Surgical Medical
Other CAI Community acquired infection Symptoms started 48 h post-
admission or 1 day For surgical patients, administration of
prophylactic antimicrobials should be checked in the previous 24
hours in order to encode the duration of prophylaxis as either one
dose, one day (= multiple doses given within 24 hours) or >1
day. MP Medical prophylaxis For example long term use to prevent
UTIs or use of antifungals in patients undergoing chemotherapy or
penicillin in asplenic patients etc. OTH OtherFor example
erythromycin as a motility agent (motilin agonist). UNKCompletely
unknown indication Select 1 possibility for each reported
antimicrobial APPENDIX III - Type of Indication
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Global-PPS data collection, entry and management 1.Data
collection on paper forms : Department (Ward) form (denominator
data) Patient form (numerator data) 2.Web-based data-entry,
verification, validation and reporting with the help of the
Global-PPS programme. URL:
http://app.globalpps.uantwerpen.be/globalpps_webpps/ 19
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20 Web-Based Data Entry (English)
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21 Register each institution
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22 Each department need to have a unique name !
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Feedback of results 1.Extraction of own data containing raw
data allowing verification and analysis of own hospital results
(excel). 2.Generation of simple, easy to use feedback on own
hospital data ready to use for local presentations. Descriptive
statistics comparing your hospital with average national (if N3
institutions) and continental results. 28
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Examples: Antimicrobial prevalence rates Adult wards 29 Ward
type All wardsAMWHO-AMWT-AMWP-AMWASWAICU Centre N patients N
treated patients % treated patients Country N patients % treated
patients Europe N patients % treated patients EU - type of centre N
patients % treated patients Web-Based PPS Report
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Antimicrobial prevalence rates by activity
CentreCountryEuropeEU type of centre Adults (>=18 year) Medical
Surgical AICU Children (=