strama - folkhalsomyndigheten.se · gunilla stridh ekman, strama uppsala län escherichia coli 61%...

Gunilla Stridh Ekman, Strama Uppsala län

Strama

Ove AnderssonPrimary care physicianStrama Uppsala län

Gunilla Stridh Ekman, Strama Uppsala län

What is Strama?

Professional network

21 Strama groups

One group for each county

Gunilla Stridh Ekman, Strama Uppsala län

What is Strama?

Mission

- decrease in antibiotic resistance

- rational use of antibiotics

Purpose: To maintain the efficacy of antibiotics

Gunilla Stridh Ekman, Strama Uppsala län

www.lul.se/stramauppsala

Gunilla Stridh Ekman, Strama Uppsala län

Local Strama-group

• County medical officer

• General practitioner

• Infectious diseases

• Pharmacists

• Nurse

• Coordinator

The team

Local partners:

• Department ofinfectious diseases

• Department ofmicrobiology

• Department ofinfection control

• Municipality nurses

• County veterinary

• Childrens health care

• Local committee ofpharmaceuticals

• Primary care chiefphysician

• Hospital chiefphysicians

• Other hospital clinics

• National dental service agents

Gunilla Stridh Ekman, Strama Uppsala län

Primary health care

• Visit health care centers 2 times anually

• Feed-back prescription pattern

• National Recommendations

• Routines

• Local agents

• Information , campaigns towards thepublic

• Education

• Local resistance studies in primary care

• Pharmacist students studies

• Educational activities towards children health care, kindergartens, nursing homes

Gunilla Stridh Ekman, Strama Uppsala län

Hospitals

• Prescription feedback

• Information – doctors

• Education – doctors, nurses and assistantnurses

• Local antibiotic doctors

• Journal reviews

• Antibiotic stewardship

• Reviewing local treatment recommendations

Gunilla Stridh Ekman, Strama Uppsala län

Prescription satistics

• National database from pharmacies

• Prescribed and collected antibiotics

• Ordered antibiotics

• ”The tool of infections” -Infektionsverktyget

• Community acquired or health care associatedinfections or prophylactic treatment

• Electronic tool

10

Swedres 2014 www.folkhalsomyndigheten.se

Antibiotic prescription in Sweden 2014

112016-08-19

Figure 1.24.

Prescription of narrow spectrum antibiotics in hospitals

Sweden 2014

122016-08-19

Figure 1.25.

* Includes all salens on requisition

Prescription of broad spectrum antibiotics in hospitals

Sweden 2014

Gunilla Stridh Ekman, Strama Uppsala län

Flouroquinolones and cephalosporins in hospitalsSweden 2013-2014

Källa: Strama Uppsala Län

Gunilla Stridh Ekman, Strama Uppsala län

Carbapenems in hospitals in Sweden 2013-2014

Källa: Strama Uppsala Län

Gunilla Stridh Ekman, Strama Uppsala län

Antibiotic prescription is decreasing in all 21 counties exceptin Uppsala

Källa: Strama Uppsala Län

Gunilla Stridh Ekman, Strama Uppsala län

Geriatric ward

Gunilla Stridh Ekman, Strama Uppsala län

Neurological ward

Gunilla Stridh Ekman, Strama Uppsala län

www.lul.se/stramauppsala

Gunilla Stridh Ekman, Strama Uppsala län

Gunilla Stridh Ekman, Strama Uppsala län

Strama Uppsala länUTI-screening 2016

Gunilla Stridh Ekman, Strama Uppsala län

Escherichia coli61%

Klebsiella pneumoniae3%

Proteus mirabilis2%

Staphylococcus saprophyticus

2%

Enterococcus faecalis2%

Staphylococcus aureus1%

Proteus vulgaris1%

grampositiv blandflora

18%

bakterier1%

Ingen växt av bakterier9%

Microbiologic findings Strama UTI-screening 2016( 176 cultures)

1 february - 3 march 2016

”bakterier”: flera olika sorters bakterier vilket beror på att provet inte tagits på rätt sätt, vanligen att man ej tagit mittstråleurin. Fynden ska inte antibiotikabehandlas.

Gunilla Stridh Ekman, Strama Uppsala län

0

5

10

15

20

25

30

35

40

Ampicillin Cefadroxil Kinoloner(=Nal 2002-08)

Mecillinam Nitrofurantoin Trimetoprim

An

del

res

iste

ns

(%)

Escherichia coli, antibiotikaresistens enligt Stramas UVI-screening inom primärvården i Uppsala län 2008 – 2016

2008 2009 2010 2011 2012 2013 2014 2015 2016

Gunilla Stridh Ekman, Strama Uppsala län2016: 8 st ESBL-A

0%

1%

2%

3%

4%

5%

6%

7%

8%

2008 2009 2010 2011 2012 2013 2014 2015 2016

An

del

ES

BL

-bil

da

nd

eProportion ESBL-forming E. coli in Strama UTI-screening

All8 ESBL E. coli in 2016 screening were sensible towards pivmecillinam and nitrofurantoin