German hospital network, AVS. Birgitta Schweicker (Germany)

Project AVS – Antibiotika-Verbrauchs-Surveillance

Birgitta Schweickert, Robert Koch-Institut, Germany

1 ARHAI-Meeting, ECDC, 12.02.2015

Responsible institution: National public health institute, Robert Koch-Institute

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Intent and purpose of the cooperation

• Establishment of a common technical platform, which facilitates the linking of data from the different surveillance systems

• Use of allready existing technical infrastructures for data upload

The webbased electronic data portal „webKess“, a longstandig tool for the submission of nosocomial infection data, has been extended for the upload of data required for antibiotic consumption surveillance (interface between hospital and the national public health institute)

Project background

National Reference Center for Surveillance of Nosocomial Infections

cooperation

ARHAI-Meeting, ECDC, 12.02.2015

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Aims of the project

• Support of the hospitals in establishment and conduct of antibiotic consumption surveillance according to the legal requirements • Efficient support of local antibiotic stewardship activities • Collection of regionally and nationally representative data • Provision of reference data

Perspective

Linkage of data from different surveillance systems

Project


Methods

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ATC (Anatomical Therapeutic Chemical)/DDD (Defined daily dose)-System of WHO

Target measure

Number of daily doses (DDD) of a substance

100 patient days (PT) and admissions

Antiinfectives J01 Antibiotics J05 Antivirals

J02 Antimycotics A07AA Intestinal antibiotics

J04A Antimycobacterials P01AB Nitroimidazol derivatives

Different medical specialties or single wards, respectively

Monthly, quaterly or yearly

Method

Organisation-level

Time interval


Data management

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Compilation of the transmitted data providing a clearly laid out overview in order to facilitate a data check with respect to correctness, plausibility and completeness of the data. It primarily serves for internal quality control purposes.

- Standard report - Ranking list - Comparison reports (benchmarking)

1. Report on transmitted data

2. Feedback reports

Access: Webbased provision by password-protected access via an interactive data base

Reporting

Time frame: Provision of feedback reports within 24 hours after successful data upload


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Feedback reports

• The participant has the possibility to specify his/her data request by selecting different parameters

- year(s) and time period for calculation

- organisational level (medical specialty/ward)

- ward type

- group of antiinfectives to be presented

- application form

- Basis of calculation

• Provision of different export formats (PDF, EXCEL,..)

Reporting


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Mask for the retrieval of feedback reports

Reporting


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Types of feedback reports

• Standard report Presentation of the actual data in comparison to previous values in order to allow for the assessment of the temporal development of the data.

• Ranking list Presentation of the data according to consumption volume of the drugs (e.g. in DDD) in descending order.

• Comparison reports Presentation of individual hospital data in comparison to aggregated data of reference hospitals (Median, mean, 25% und 75% Percentile).

Reporting


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Reporting


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Standard report: presentation of the temporal course of consumption data

Hospital X

Year(s): 2013; 2014 Time interval: yearly

Organisation level: Medical speciality Organisational unit: Surgery

Ward type: General ward Measure: DDD

Antiinfectives: Betalactam antibiotics, Pen Application form: entire

2013 2014

Wirkstoffgruppe DDD DDD/100 PD DDD/100 AD DDD DDD/100 PD DDD/100 AD

J01C-Beta-lactam-antibacterials, Penicillins 22,084 27.0 197.1 15,459 23.6 175.8

J01CA-Penicillins with extended spectrum 730 0.9 6.5 400 0.6 4.5

J01CA01-Ampicillin 370 0.5 3.3 120 0.2 1.4

J01CA04-Amoxicillin 360 0.4 3.2 280 0.4 3.2

J01CE-Beta-Lactamase-sensitive Penicillins 1,432 1.7 12.8 1,073 1.6 12.2

J01CE01-Benzylpenicillin 1,300 1.6 11.6 1,008 1.5 11.5

J01CE02-Phenoxymethylpenicillin 127 0.2 1.1 59 0.1 0.7

J01CE08-Benzylpenicillin-Benzathin 4 0.0 0.0 5 0.0 0.1

J01CF-Beta-Lactamase-resistent Penicillins 567 0.7 5.1 380 0.6 4.3

J01CF05-Flucloxacillin 567 0.7 5.1 380 0.6 4.3

J01CR-Combination of Penicillins, incl. Beta-Lactamase-Inhibitors

19,356 23.7 172.7 13,607 20.8 154.8

J01CR01-Ampicillin and Enzym-Inhibitors 14,712 18.0 131.3 9,854 15.0 112.1

J01CR02-Amoxicillin and Enzym-Inhibitors 2,210 2.7 19.7 1,610 2.5 18.3

J01CR05-Piperacillin and Enzym-Inhibitors 2,434 3.0 21.7 2,143 3.3 24.4

Reporting

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Standard-report, graphical presentation

AVS – Reporting


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Reporting


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Ranking list Hospital X

Year(s): 2013; 2014 Time interval: yearly

Organisation level: Medical speciality Organisational unit: all

Ward type: entire Measure: DDD

Antiinfectives: antibiotics Application form: entire

Antiinfective 2013 2012

Rank DDD % Rank DDD %

Gesamt 317,053 100.00 312,588 100.00

J01DC02-Cefuroxim 1. 68,135 21.49 1. 71,771 22.96

J01MA02-Ciprofloxacin 2. 21,874 6.90 2. 17,357 5.55

J01CR05-Piperacillin und Enzym-Inhibitoren 3. 20,398 6.43 3. 17,305 5.54

J01CR01-Ampicillin und Enzym-Inhibitoren 4. 16,425 5.18 4. 14,372 4.60

J02AC01-Fluconazol 5. 13,153 4.15 5. 13,525 4.33

J01EE01-Sulfamethoxazol und Trimethoprim 6. 12,071 3.81 8. 12,025 3.85

J01DH02-Meropenem 7. 11,985 3.78 9. 10,038 3.21

J01FA09-Clarithromycin 8. 10,590 3.34 6. 13,413 4.29

J01CE01-Benzylpenicillin 9. 10,166 3.21 13. 7,861 2.51

J01CA01-Ampicillin 10. 9,463 2.98 10. 9,410 3.01

J01DD04-Ceftriaxon 11. 9,365 2.95 7. 12,798 4.09

J01XD01-Metronidazol 12. 8,873 2.80 11. 9,040 2.89

J01CF05-Flucloxacillin 13. 7,946 2.51 18. 6,369 2.04

J01XA01-Vancomycin 14. 7,611 2.40 17. 6,422 2.05

J04AB02-Rifampicin 15. 7,074 2.23 16. 6,994 2.24

J01CA04-Amoxicillin 16. 6,860 2.16 14. 7,110 2.27

J01FF01-Clindamycin 17. 6,665 2.10 15. 7,017 2.24

J01MA12-Levofloxacin 18. 5,750 1.81 12. 8,404 2.69

J05AB01-Aciclovir 19. 4,073 1.28 19. 5,068 1.62

J02AC03-Voriconazol 20. 3,848 1.21 22. 3,854 1.23

J01DH51-Imipenem und Enzym-Inhibitoren 21. 3,351 1.06 20. 4,083 1.31

J02AA01-Amphotericin B 22. 2,655 0.84 26. 2,304 0.74

J01DD02-Ceftazidim 23. 2,635 0.83 21. 3,918 1.25

J01AA02-Doxycyclin 24. 2,395 0.76 24. 2,710 0.87

J04AC51-Isoniazid, Kombinationen 25. 2,350 0.74 23. 3,033 0.97

J05AB14-Valganciclovir 26. 2,340 0.74 31. 1,590 0.51

J01MA14-Moxifloxacin 27. 2,285 0.72 28. 2,138 0.68

J01FA01-Erythromycin 28. 2,130 0.67 25. 2,341 0.75

J01XX08-Linezolid 29. 1,875 0.59 29. 1,809 0.58

P01AB01-Metronidazol 30. 1,816 0.57 27. 2,268 0.73

75%

90%

Reporting

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• Comparison reports (benchmarking) Presentation of individual hospital data in comparison to aggregated data of reference hospitals (Median, mean, 25% und 75% Percentile).

Reporting


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Comparison report I, table form

*AC, antibiotic consumption

Reporting

Hospital X

Year: 2013 Organisational unit: Surgery

Organisational level: Medical speciality Time interval: yearly

Ward type: general ward Calculation: DDD

Antiinfectives: Penicillins with extended spectrum Application form: all

Reference hospitals

Hospital size: >400 Beds Number of reference hospitals: 25

Level of care: Tertiary care Medical department: surgical

Referenzdaten

Antiinfective AC*

hospital Mean 25th Percentile Median 75th Percentile Range

DDD/

100 PD DDD/

100 PD DDD/100 PD

DDD/ 100 PD

DDD/100 PD DDD/

100 PD

J01CA Penicillins with extended Spectrum

67.4 26.3 48.1 87.6 67.4 26.3

J01CA01 Ampicillin (p) 22.2 4.6 15.1 29.3 22.2 4.6

J01CA01 Ampicillin (o) 0.2 0 0 0 0.2 0

J01CA04 Amoxicillin (p) 0.1 0 0 0 0.1 0

J01CA04 Amoxicillin (o) 11.7 1.8 7.4 18 11.7 1.8

J01CA10 Mezlocillin p) 4.1 0 0 0.4 4.1 0

J01CA12 Piperacillin (p) 29.2 0 4.4 37.3 29.2 0


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Comparison report I, graphical presentation

Reporting


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Comparison report II, graphical presentation

Reporting


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Webside

https://[email protected]

Contact: [email protected] ARHAI-Meeting, ECDC, 12.02.2015

https://[email protected]/

20 ARHAI-Meeting, ECDC, 12.02.2015

Project schedule

• Pilotphase Start in September 2014 Validation of the system with respect to content and technical aspects.

Result: functioning system, which allows transition to the routine phase

• Routinephase I Since December 2014 Ongoing evaluation (questionnaire)

Current status Registrations: 52 hospitals 10 hospitals allready passed the full cycle (data preparation and upload, retrieval of feedback-reports)

• Routinephase II Provision of reference data to the medical public

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Marcel Feig Sebastian Kärsten Tim Eckmanns Muna Abu Sin Hermann Claus Doreen Richter Hans-Peter Blank

Institute for Hygiene und Environmental Medicine Michael Behnke Luis A. Pena Diaz Philip Swarowsky Petra Gastmeier

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Department: Nosocomial infections, Surveillance of antibiotic resistance and -consumption

Health & Medicine

German hospital network, AVS. Birgitta Schweicker (Germany)