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59 danmap 2015 5. antimicrobial
consumption
in humans acute disease demands quick action with no time for allergic investigation. the
consumption
of carbapenems was 4.10 dbd in 2015, al- most unchanged to 2014 (4.09 dbd) in spite of the described shortage of the drug. in 2006 the
consumption
was 1.38 dbd, an increase of 297% for the decade. thus in spite of recom- mendations from the national board of health on the reduced use of carbapenems and delivery problems for meropenem during the summer of 2014 and in 2015 no apparent decrease in the
consumption
of meropenem was
observed
. 5.4.3 other measures of somatic
hospital
consumption
ddd per 100 admissions (dad) because of the
observed
changes in the number of
hospital
bed-days over time, the
consumption
of antimicrobials in danish
hospital
s may also be measured in relation to admis- sions (i.e. ddd per 100 admissions, dad). when expressed as dad, the total
consumption
of antimicrobial agents in somatic
hospital
s showed a decrease from 2014 to 2015 (from 324.1 dad to 313.4, - 3.3%) (table 5.6). among the leading individual antimicrobial groups, increases for the year 2014 to 2015 were
observed
for ?combination penicillins? (8.7%), penicillins with extended spectrum (1.6%) and macrolides (15%). decreases were
observed
for most other antimicrobials: beta-lactamase sensitive penicillins (-4.6%), 2nd generation cephalosporins (-13%), fluoroquinolones (- 7.9%) and to a lesser extent for carbapenems (-1.6%). as
observed
for the
consumption
measured in dbd, increases were also
observed
for the rarely used tetracyclines and line- zolid (5.2% and 26%, respectively), while vancomycin showed a marked decrease (-82%). during the past decade, dad increased by 9.1%; an increase primarily driven by a higher number of ddds but counterbal- anced by an increase in the number of
hospital
admissions. when compared to the
consumption
in primary health care, and thus calculated in did, the
consumption
of antimicro- bial agents in somatic
hospital
s decreased from 2.18 did in 2014 to 2.04 did in 2015. during the past decade, the dids consumed at
hospital
s have increased by 13% (1.81 did in 2006), (table a5.4 in web annex). 5.5. comments on 20 years surveillance of
consumption
while the
consumption
kept rising through the beginning of the new century, so were the occurrences of resistance in human pathogen bacteria. already in 2000, time series analysis were introduced in danmap for measuring the effect of interventions on the control of the antimicrobial
consumption
. in 2004 a detailed analysis of changes in
consumption
of the different antimi- crobial classes were given (figur 5.15); these show the same trends
observed
for 2015, namely shifts from
consumption
of the most narrow spectrum classes to more broadspec- trum classes. in 2007 the barometer of antibacterials was introduced to give a more timely and appropriate picture of the
consumption
by reporting quarterly changes in chosen antimicrobials classes. unfortunately it has not been possible to maintain these addiditional surveillance functions. despite these different attempts on measuring the antimicro- bial
consumption
, no significant effect on neither
consumption
nor development in resistance were
observed
. among emerg- ing resistances in clinical human bacteria were the outbreak of a multiresistant klebsiella pneumoniae at hillerød
hospital
in northern zealand in 2008, the almost simultaneously increas- ing occurrence of clostridium difficile in the capital region of denmark, followed by occurrence of the first ndm-1 positive strain of klebsiella pneumoniae as well as a
hospital
outbreak of vancomycin resistant enterocci at skejby
hospital
in 2010 (see danmap 2009 to 2011 for information). resistance outbreaks certainly would have been much bigger if no awareness on the
consumption
and constant surveillance had taken place. the simultaneously increas- ing resistances in other european countries combined with the described outbreaks were alarming and functioned as a trigger for the initiation of several efforts happening on local regional
hospital
levels. among these were strong efforts to reduce the
consumption
of cephalosporins and fluoroquino- lones. national recommendations regarding more prudent use of antimicrobials were issued by the national health authori- ties in 2012. these give restrictions on the use of cephalo- sporins and fluoroquinolones for both health sectors and for the use of carbapenems at
hospital
s (see danmap 2012) . even though the primary sector accounts for almost 90% of the antimicrobial
consumption
it has proven much more dif- ficult to establish good and stable systems of antimicrobial stewardship here. comprehensive research is undertaken these years investigating on the use of diagnostic tools as well as supporting the implementation of rational antimicro- bial use. the danish system with detailed surveillance of consump- tion combined with the surveillance of occuring resistance has so far proven to prevent steep increases in these. future efforts must continue to focus on prudent use, which not only includes lowering the total
consumption
but applying the achieved knowledge on the complex interplay between
consumption
of specific antimicrobial drugs and emergence of resistance in every way. here a special focus must be paid on the
consumption
of fluoroquinolones and other more broad spectrum antimicrobials in the primary sector. maja laursen, katrin gaardbo kuhn and ute wolff sönksen,. for further information: uws@ssi.dk
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