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


What is Strama?

Professional network

21 Strama groups

One group for each county


What is Strama?

Mission

- decrease in antibiotic resistance

- rational use of antibiotics

Purpose: To maintain the efficacy of antibiotics


www.lul.se/stramauppsala


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


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


Hospitals

• Prescription feedback

• Information – doctors

• Education – doctors, nurses and assistantnurses

• Local antibiotic doctors

• Journal reviews

• Antibiotic stewardship

• Reviewing local treatment recommendations


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


Flouroquinolones and cephalosporins in hospitalsSweden 2013-2014

Källa: Strama Uppsala Län


Carbapenems in hospitals in Sweden 2013-2014



Antibiotic prescription is decreasing in all 21 counties exceptin Uppsala



Geriatric ward


Neurological ward


www.lul.se/stramauppsala

Strama Uppsala länUTI-screening 2016


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.


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

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

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