Hotet från omvärlden ökar
Increased knowledge on an increasing problem
number of hits in Pub-MED for (antibiotic or antimicrobial) + resistance by 5 year’s periods
02 0004 0006 0008 000
10 00012 00014 00016 00018 000
1965-70
1971-75
1976-80
1981-85
1986-90
1991-95
1996-2000
2001-05
Reviews
Original publ.
MRSA in Europe 2004. Data from EARSS.
0 10 20 30 40 50 60 70
Iceland Norway Sweden Holland
Denmark Finland Estonia
Czech rep. Slovenia Austria
Hungary Luxembourg
Slovakia Poland
Germany (267)BulgariaLettland
Latvia Spain
France Belgien Croatia
Israel Italy
Ireland United
Greece Portugal Cyprus
Malta Romania
% MRSA
• Crude estimate from Israel: 4% of all fatalities in hospitals related to Gram-neg multiresistant nosocomial inf. (Carmeli 2005)
• Crude estimate from EU-15: 5,800 excess deaths in ICU related to resistance (Harbarth et al 2005)
• Rough estimate of global gonnorhoea treatment failure:3 million cases annually (of total 62 million cases) (Tapsall 2005)
The tip of the iceberg…
The Current ParadoxThe Current ParadoxThe Current ParadoxThe Current Paradox
AntibioticAntibiotic
ResistanceResistance
AntibioticAntibiotic
ResistanceResistance
DrugDrug
DevelopmentDevelopment
DrugDrug
DevelopmentDevelopment
Sveriges beredskap är god?
Sales of Antibiotics in the Nordic Countries
1978-2004 D
DD
/100
0 in
habi
tant
s/da
y
-
5
10
15
20
25
19
78
19
79
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
Iceland
Finland
Sweden
Norway
Denmark
www.reactgroup.org
Sveriges beredskap är god?
Optimal sjukhusanvändning?Optimal kinolonanvändning?Optimal diagnostik?Optimal hygien?Optimal profylax?
Guidelines does not work unless they are implemented !
Implementation does not work unless there is local comittment and educational outreach !