Michiel Costers

National campaigns to improve antibiotic use.

High levels of antibiotic consumption are driving levels of bacterial resistance that threaten public health. Nonetheless, antibiotics still provide highly effective treatments for common diseases with important implications for human health. The challenge for public education is to achieve a meaningful reduction in unnecessary antibiotic use without adversely affecting the management of bacterial infections. This paper focuses on the lessons learned from national campaigns in countries (Belgium and France) with high antibiotic use. Evaluation of these national campaigns showed the importance of television advertising as a powerful medium to change attitudes and perhaps also behaviour with regard to antibiotics. Moreover, in both countries, strong evidence suggested reduced antibiotic prescribing. However, adverse effects associated with a reduction in antibiotic prescribing were not monitored. We conclude that carefully designed mass education campaigns could improve antibiotic use nationally and should be considered in countries with high antibiotic use. However, these campaigns should employ techniques of social marketing and use appropriate outcome measures. The benefits and risks of such campaigns have been less well established in countries where antibiotic use is already low or declining.

The first European Antibiotic Awareness Day after a decade of improving outpatient antibiotic use in Belgium.

More than 10 years ago ‘The Microbial Threat’ was the fi rst of a series of invitational EU conferences making antimicrobial resistance an offi cial EU issue. (1) Its recommendations initiated the European Antimicro-bial Resistance Surveillance System (EARSS; www.rivm.nl/earss), the European Surveillance of Antimicrobial Consumption (ESAC; www.esac.ua.ac.be), and the es-tablishment of antimicrobial National Focal Points like, for Belgium, the Belgian Antibiotic Policy Coordination Committee (BAPCOC; www.health.fgov.be/antibiotics). EARSS and ESAC data identifi ed Belgium as one of the countries with high consumption and resistance, two characteristics signifi cantly associated at an ecological level in Europe, (2) as well as showing a cause-effect relationship in a randomised controlled trial with healthy volunteers. (3) And since for humans most antibiotics are being consumed in ambulatory care, during the last decade several measures were adopted in Belgium at the national level to improve antibiotic use in ambulatory care. And these measures did not miss their effect on both outpatient antibiotic use and antimicrobial resistance.

Implementation of antibiotic management teams in Belgian hospitals

Abstract In 2002-03, the Belgian government subsidized in part the activities of local Antibiotic Managers (AMs) in 36 hospitals selected based on the presence of an operational multidisciplinary Antibiotic Management Team (AMT). AMs were trained as Internists (28), Microbiologists (13) and Hospital Pharmacists (13). The hospitals were representative of Belgian hospitals in affiliation, regional origin and size. The financing scheme allowed the implementation of 175 antibiotic management interventions, with a mean of 5 interventions/hospital. The activities reported in the first 9-month progress reports were analyzed according to national guidelines for AMTs. All hospitals irrespective of size or affiliation had undertaken a wide range of measures: review of formulary (29), implementation of new clinical guidelines (24), restricted access to selected antibiotics (25), improvement of antibiotic susceptibility testing methods (12), development of antibiotic consumption database (35) and analysis of antibacterial susceptibility data (31). Advertisement type categorization of communication methods showed that education of prescribers was based on multimodal communication. All hospitals used at least one passive method, 39% at least one active method and 55% at least one personalized method. The quality of communication was higher in hospitals with teaching affiliation. In conclusion, hospitals that received a financial incentive under the AMT pilot phase have developed multimodal antibiotic policy interventions independently of the hospital size and teaching status. Extension to all Belgian hospitals appears warranted. The impact of AMTs and AMs on the quality of use of antibiotics and trends of antibiotic resistance and cost will be monitored based on standardized indicators.

Hospital antibiotic management in Belgium – results of the ABS maturity survey of the ABS International group

ZusammenfassungHINTERGRUND: Während die Diskussion, welche Programme zur Verhinderung von Resistenzproblemen in Spitälern die größte Wirkung zeitigen, noch nicht beendet ist, fehlen Daten darüber, welche Programme überhaupt schon implementiert sind. Im Rahmen des Projektes ABS – International wurde eine Umfrage über die Implementierung und die Charakteristika derartiger Antibiotika-Management-Programme in mehreren europäischen Ländern durchgeführt. In dieser Publikation werden die Resultate für Belgien vorgestellt. In Belgien gibt es seit dem Jahr 2002 ein staatlich getragenes Programm zur Entwicklung multidisziplinärer Antibiotika-Management-Arbeitsgruppen. METHODIK: Ein Fragebogen wurde im April und Mai 2007 an die ärztlichen Direktoren, bzw. die Vorsitzenden der Arzneimittelkommissionen aller Akutspitäler Belgiens ausgesandt. Die 39 Fragen umfassten fünf Aspekte des Antibiotika-Managements im betreffenden Spital und mussten nach einem Punktescore von 0 (fehlt) bis 5 (vollständig vorhanden) bewertet werden. ERGEBNISSE: Von 120 Fragebögen wurden 46 (38%) für eine Analyse ausreichend beantwortet. Die Krankenhäuser der retournierten Fragebögen waren über die drei Regionen des Staates gleichmäßig verteilt. Der mittlere Punktescore von 3,75 (Streuung 2,15–4,90) deutet auf das Vorhandensein gut entwickelter AB-Management-Systeme in den meisten Spitälern hin. In über 90% der Häuser sind die wesentlichen strukturellen Ressourcen und Instrumente für ein funktionierendes AB-Management-Programm vorhanden. Besonders hochwertig wurden die Einrichtungen zur mikrobiologischen Diagnostik und der Resistenzerfassung (4,41) eingeschätzt, ebenso als gut bewertet wurden die Erhebung des AB-Verbrauchs (4,16), sowie das Vorhandensein und die Tätigkeit geschulter AB-Beauftragter (3,81). Professionelle Personalentwicklung (3,43) und die Kooperation mit den extramuralen Einrichtungen (2,95) erhielten niedrigere Bewertungen. Für Spitäler, an denen schon länger hauptamtliche AB-Beauftragte tätig waren, waren die Punktezahlen für das allgemeine AB-Management durchwegs höher, nicht aber die für Diagnostik. SCHLUSSFOLGERUNG: In belgischen Spitälern sind AB-Management-Programme gut etabliert, insbesondere in Häusern in denen sie staatlich gefördert werden. Eine Ausweitung der finanziellen und technischen Unterstützung könnte allen Spitälern helfen, auf einem entsprechend hohem Niveau zu arbeiten; Schwerpunkte sollten eine adäquate Förderung der diagnostischen Einrichtungen und der kontinuierlichen Ausbildung von AB-Spezialisten sein.SummaryBACKGROUND: While debate about optimal organization for hospital antibiotic stewardship programs is ongoing, limited information is available about the implementation of such programs in acute-care institutions. The ABS International project conducted a survey on the implementation and characteristics of hospital antibiotic management programs in several European countries. This paper summarizes the results for Belgium, where a federal program for developing multidisciplinary antibiotic management teams was started in 2002. METHODS: The survey was conducted in April and May 2007. A questionnaire with 39 items to be scored from 0 (absent) to 5 (fully available) was sent to medical directors and chairs of drugs and therapeutics committees in all acute-care hospitals to measure five dimensions of hospital antibiotic management. The results were analyzed by calculating the mean scores for the various items and topics. MAIN FINDINGS: Of 120 questionnaires sent, 46 (38%) were completed and returned in time for analysis. The three regions of the country were well represented by the respondents. The mean country maturity score of 3.75 (range 2.15–4.90) indicated that a well developed antibiotic management system was in place in most hospitals. Over 90% of hospitals had key structural resources and tools available for effective stewardship programs. Performance items that scored high were those related to microbiological diagnostics and surveillance of bacterial resistance (4.41), surveillance of antibiotic consumption (4.16) and organization of antibiotic guidance and support by trained antibiotic management officers (3.81). Items that scored lower were professional development of personnel (3.43) and co-ordination with outside healthcare providers (2.95). Hospitals with several years of funding for their antibiotic officer showed higher scores for antibiotic management but not for diagnostics. CONCLUSIONS: Antibiotic stewardship programs are well developed in Belgian hospitals, particularly in those which first qualified for federal support. Extension of funding and technical assistance should help all hospitals to catch up with excellence standards, provided that adequate support is given to laboratory services and advanced training of professional specialists.