AMS Case Study – EGYPT
National Antimicrobial Stewardship Program
Rational Drug Use (RDU) DepartmentHospital Pharmacy Administration HPA
CAPA
Aalaa AfdalB.Sc Pharm, M.Sc Pharm, BCPS,
ASP Pharmacist
1- Introduction
2- National Antimicrobial Stewardship Program
3- Egyptian Point Prevalence Survey
4- Results
5- Conclusion
Outline
1
Introduction
2
1
National Antimicrobial Stewardship Program (NASP)
3
Problem In Egypt
Antimicrobial Misuse and Resistance World Wide
(Global Calls)
MOH OneHealth National
Action PlanFor
Combating AMR
WHO CallFor Policy
Makers
Project In Many
Countries Drug
Authorities
National Antimicrobial Stewardship Program (NASP)
4
Antimicrobial Misuse and Resistance World Wide
(Global Calls)
Antimicrobial use in Egypt
5
Data on Antimicrobial Use in Egypt
Sporadic
Minors
Unstandardized
6
GAP
Set Up Governance Structures
Surveillance SystemRegular Antimicrobial Use and Consumption
InterventionRational Use of Antimicrobials
Track and Measure Progress
of The NASP
Conduct Awareness Campaigns
Global Action Plan
Egyptian National Action Plan Fighting AMR
• Four Main Pillars
7
Infection Prevention & control
Optimizing AB use
AMR surveillance
Education & public
Awareness
National Antimicrobial Stewardship Program
8
2
9
NASP
Set Up Governance Structures
Specify Antimicrobial Use measures
Conduct training & Awareness Campaigns
Do Interventions and follow up
1
23
4
Hospital Level
National Level
10
NASP
Set Up Governance Structures
Specify Antimicrobial Use measures
Conduct training & Awareness Campaigns
Do Interventions and follow up
1
23
4
1- Set Up Governance Structures
11
National level (NAP-AMR)
Stakeholders meetings in collaboration with the WHO.
Three Mega meetings (April 2017 - Nov 2017 -March 2018).
Followed by multiple taskforce meetings (finalization).
N-AMS Committee
1- Set Up Governance Structures
12
National level (CAPA)
Introduction of Antimicrobial Formulary list.
Updated OTC list excluding systemic antimicrobial agents.
Rational Drug Use Publication (4\2017) of ASP in hospitals.
1- Set Up Governance Structure
13
Hospital level (CAPA)
14
NASP
Set Up Governance Structures
Specify Antimicrobial Use measures
Conduct training & Awareness Campaigns
Do Interventions and follow up
1
23
4
2-Specify Antimicrobial Use measures
15
National level Hospital level
DDD/1000 inhabitants
DDD/100 bed days
DOT/100 bed days
Point
Use
Quality Quantity
16
NASP
Set Up Governance Structures
Specify Antimicrobial Use measures
Conduct training & Awareness Campaigns
Do Interventions and follow up
1
23
4
3- Conduct trainings
17
AMR Awareness
AMS Activities
18
NASP
Set Up Governance Structures
Specify Antimicrobial Use measures
Conduct training & Awareness Campaigns
Intervene and follow up
1
23
4
4- Intervene and follow up
19
Hospital level (CAPA)
1. Use Specific Antibiotic prescribing sheet
2. Generate Quality indicators of antimicrobial prescribing
3. Promote Culture withdrawal promptly
4. Enforce Data specific Interventions5. Follow up data
The Egyptian Point Prevalence Survey Of Antimicrobial
Consumption And Resistance (E-PPS)
20
3
Egyptian PPS aims to :
21
1. Monitor rates of antimicrobial prescribing in hospitalized adults, Pediatrics and Neonates.
2. Identifies targets for quality improvement (e.g. duration of peri-operative prophylaxis; compliance with local hospital guidelines; documentation of indication for prescription of antibiotic therapy).
3. Helps in designing hospital interventions that aim at promoting prudent use of antimicrobials.
4. Allows to assess the effectiveness of such interventions, through repeat PPS.
22
E-PPS
• conducted in 17 hospitals (1388 patients
) from 4 different governorates (Cairo-Giza-Qualyobia-Alex)
within the directorates and SMCs.
First Wave (2017)
• conducted at 41 hospitals (2542 patients) Cairo-Giza-Qualiobia-Alex-Behira-Baniswef-Dakhlia-Menofia-Alfayoum) from different sectors
MOH (Directorates, Educational and Health insurance sector, SMCs),
Universities (Menofia) and Interior Ministry.
Second Wave (2018)
• 5 pilot hospitals plus 4 additional enthusiastic hospitals in 4 different directorates (Damitta, Qalyoubia, Fayoum,
Alexandria)
Third Wave (2019)
E-PPS
24
Results reports Hospitals feedbackHospitals Interventions
4- Intervene and follow up
25
E-PPS Event (first wave)
Results
26
4
27
4,995 antimicrobial prescriptions
4,498 (90.0%) antibacterials for systemic use (ATC J01)
149 (3.0%) antimycotics for systemic use (ATC J02)
58 (1.2%) drugs to treat tuberculose (ATC J04)
99 (2.0%) nitroïmidazole derivatives (ATC code P01AB)
35 (0.7%) intestinal anti-infectives (ATC code A07)
156 (3.1%) antivirals for systemic use (ATC code J05)
28
0
5
10
15
20
25
Ceftriaxone CefotaximeAmpicillin and enzyme inhibitorMetronidazoleAmoxicillin and enzyme inhibitorMeropenem
Top prescribed antibiotics
2017 2018
%
%
%
%
%
%
E-PPS
29
Surgical proph, 5.50%SSTIs, 7.30%
sepsis, 7.60%
PUO, 2.20%
Pneu, 35.70%CNS, 10.60%
GI, 6.00%
FN, 3.60%
UNK, 12.20%
Bron, 7.40%
Most common diagnosisE-PPS
30
18.6
3%
14.8
2%
12.5
4%
6.46
%
3.82
%
5.48
%
3.65
%
9.14
%
27.4
0%
7.92
%
0%
5%
10%
15%
20%
25%
30%
The Most Prevalent Antibiotics for LRTI In Egypt
Adults
Paediatrics
E-PPS
31
GUIDELINE COMPLIANCE
15%
85%
STOP/REVIEW DATE DOCUMENTATION
YesNo
Yes41%
No32%
NA16%
No information11%
E-PPS
32
85%
15% 0%
ROUTE OF ADMINISTRATION
Parentral
Oral
Inhalation0.2%
NoYes
REASONS IN NOTES
Targeted
Emperic
TREATMENT
7.3% Biomarker based96%
4%
E-PPS
33
Selection hospitals with ≥ 10 patients receiving surgical
prophylaxis (n=14 hospitals)
SP1 = Single doseSP2 = One daySP3 = > 1 day
E-PPS
Conclusion
34
5
Targets for Improvement
35
Decrease the prevalence of broad spectrum beta lactams antibiotic use in different wards
Encourage culture based treatments – Biomarkers Develop guidelines and ensure compliance Enforce quality indicators for antimicrobial prescribing Rationalize the use of Parenteral Antimicrobials
36
E-PPS fortune
Tailored interventions according to the available resources of each institution:
Development of Antibiotic policy Development of Surgical prophylaxis policy Development of restricted list of Antibiotics Development of IV to Oral therapy shift policy Establishment of Prospective audit for Antimicrobial use Conduction of Educational programs Development of Antibiograms Development of updated formulary list
Limitations
37
Inconsistent sustainability of supportive administration Insufficient resources, tools, and materials supporting ASP
activities (e.g. Culture Discs, Qualified human resources, poor culture withdrawal techniques, automated software….)
Weak multidisciplinary coordination Resistance of some prescribers Insufficient awareness of proper AB use and AMR for different
HCPs Shortage of some empiric antimicrobials
SPECIAL THANKS TO:
WHO – AMR team IPC Admin. MoHP Central Lab MoHP NASP members Head of HPA Head of CAPA
38
39
40
AMS
Any Questions!!!
�AMS Case Study – EGYPT��National Antimicrobial Stewardship Program��Rational Drug Use (RDU) Department�Hospital Pharmacy Administration HPA�CAPAOutlineIntroductionNational Antimicrobial Stewardship Program (NASP)National Antimicrobial Stewardship Program (NASP)Antimicrobial use in EgyptSlide Number 7Egyptian National Action Plan Fighting AMRNational Antimicrobial Stewardship ProgramSlide Number 10Slide Number 111- Set Up Governance Structures1- Set Up Governance Structures1- Set Up Governance StructureSlide Number 152-Specify Antimicrobial Use measuresSlide Number 173- Conduct trainingsSlide Number 194- Intervene and follow upThe Egyptian Point Prevalence Survey Of Antimicrobial Consumption And Resistance (E-PPS)�Egyptian PPS aims to :�Slide Number 23E-PPS4- Intervene and follow upResults�Slide Number 27Slide Number 28Slide Number 29Slide Number 30Slide Number 31Slide Number 32Slide Number 33ConclusionTargets for ImprovementSlide Number 36LimitationsSPECIAL THANKS TO:Slide Number 39Slide Number 40
