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  • Gunilla Stridh Ekman, Strama Uppsala län

    Strama

    Ove Andersson Primary care physician Strama 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 of infectious diseases

    • Department of microbiology

    • Department of infection control

    • Municipality nurses

    • County veterinary

    • Childrens health care

    • Local committee of pharmaceuticals

    • Primary care chief physician

    • Hospital chief physicians

    • 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 the public

    • 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 assistant nurses

    • 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 associated infections 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 hospitals Sweden 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 except in 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 län UTI-screening 2016

  • Gunilla Stridh Ekman, Strama Uppsala län

    Escherichia coli 61%

    Klebsiella pneumoniae 3%

    Proteus mirabilis 2%

    Staphylococcus saprophyticus

    2%

    Enterococcus faecalis 2%

    Staphylococcus aureus 1%

    Proteus vulgaris 1%

    grampositiv blandflora

    18%

    bakterier 1%

    Ingen växt av bakterier 9%

    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

    A n

    d el

    r es

    is te

    n s

    (% )

    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 län 2016: 8 st ESBL-A

    0%

    1%

    2%

    3%

    4%

    5%

    6%

    7%

    8%

    2008 2009 2010 2011 2012 2013 2014 2015 2016

    A n

    d el

    E S

    B L

    -b il

    d a

    n d

    e Proportion ESBL-forming E. coli in Strama UTI-screening

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