ARK-Hospital SAM talk 07_09_17

34 Pages·2017·1.72 MB·English

by  Martin Llewelyn

The International Convention Centre (ICC), Birmingham
11 – 12 September
2017
Antibiotic Review Kit - Hospital
(ARK-hospital)
Elizabeth Cross
Brighton and Sussex University Hospitals NHS Trust
Brighton and Sussex Medical School
Overview
• Background – 10 mins
• Introducing ARK-Hospital – 4 mins
• Findings from feasibility study – 4 mins
• Questions – 2 mins
Antimicrobial resistance….
Successful surgery
Cancer chemotherapy AMR the end of modern medicine
Immunotherapies
Antimicrobial resistance by 2050
threatens:
• A reduction in the world economy of
0.1-3.1%
Taylor J, et al. Estimating the economic costs of antimicrobial resistance: model
and results. 2015. http://www.rand.org/
WHO Antimicrobial Resistance Global Report on Surveillance 2014
randeurope/research/projects/antimicrobial-resistance-costs.html

‘The English Miracle’1
Introduction of targets
Financial penalties
Substantial changes in antibiotic use
Cephalosporins and Quinolones 
β-lactam/β-lactamase inhibitors 
Cooke J, et al. Longitudinal trends and cross-sectional analysis of English national hospital antibacterial use over 5
years (2008–13): working towards hospital prescribing quality measures JAC 2015
45
The challenge of antibiotic
resistant GNRs in the UK 40
2010
2011
35
• >3x increase in E . coli bacteraemia 2012
2013
since 2004
30
2014
• Currently 36,000 cases / year
t
n
a
t
Rates of resistance to key agents… si25
s
e
r

s
Gentamicin e
t
a
l20
o
Ciprofloxacin s
I

%
Co-amoxiclav
15
Piperacillin – tazobactam
10
….climbing alarmingly
46% of E. coli bacteraemia isolates now
5
reported as co-amoxiclav resistant
0
E. coli - Co-amox K. pneumoniae - Pip-tazo
English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2015
Some typical local data
Some key rates of antibiotic resistance at this trust in 2016
E. coli cultured from urine Enterobacteriaceae
cultured from blood
Co-amoxiclav 27% 39%
Ciprofloxacin 12% 19%
Piperacillin-tazobactam 14% 16%
Gentamicin 10% 14%
At what rate of resistance would these drugs cease to be reliable clinically
selected treatments?
• If you don’t believe predictions of a world without antibiotics by 2050
• Imagine working in your hospital without these antibiotics by 2020
Antibiotics also place individual patients at risk of
resistant infection
• Explored relationship between prior antibiotic use and antibiotic resistance
• Reviewed 24 studies
– 19 Observational • Urinary Infections
– 5 RCTs
• Respiratory Tract infections
– >27,000 participants
Forest plots of included studies
Substantial
Lasting
Urinary Infection Respiratory Tract Infection 9
Option 1 - Don’t start!
Always begin broad-
spectrum intravenous
antibiotics within the first
hour!
10