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DANMAP 2015 3D
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danmap 2015 62
antimicrobial
consumption in humans 5. hospitals abroad. the other outbreak consisted of two persons (a couple) in maniitsoq and the husband was a cancer-patient who was treated for a long period of time in a danish hospital. when the patient was referred back to maniitsoq hospital he had a wound infection with mrsa (t002 cc5) and his wife became colonized in the nose with the same strain. close family contacts and a few nurses were examined for mrsa but none of these had mrsa. both outbreaks illustrates the fact that mrsa is mainly spread by close contact in families, and rarely to other contacts in the community. in spite of outbreaks in denmark with vre, so far only one patient has been diagnosed with vre in greenland. this was a five- months-old child being colonized in the rectum with vre after admission to a danish hospital. the mother of the child and other close family members were examined but none of these were colonized with vre and no transmission was seen
at the ward. most of the other resistant bacteria were imported from denmark or abroad, but in some cases, especially in patients with esbl-producing enterobacteriaceae, treatment with broad-spectrum antimicrobial agents
in greenland has probably selected for these bacteria. since 2011, there has been an increasing problem with c. difficile infections (mainly type 027) in the hos- pitals, and transmission within the country has occurred. a project focusing on identification of risk factors for acquisition of c. difficile infections, mapping of c. difficile types and prevention strategies will be performed in the future. consumption of antimicrobial agents: all antimicrobial agents in greenland are purchased and disseminated from the national pharmacy. figure 1 shows the total purchase of selected antimicrobial agents in ddd per 1,000 inhabitants per day (did) from 2007 to 2015. from 2007?2013, an increase of narrow-spectrum (18%) and broad-spectrum penicillins (12%) has been seen, but from 2013 to 2014 a decrease of 23% and 4%, respectively, has occurred. an increase was seen again from 2014 to 2015 of 31% and 28%, respectively. from 2014 to 2015 a minor increase in broad-spectrum antimicrobial agents such as macrolides (5%), tetracyclines (6%), and cephalosporins (7%) has been seen. meropenem increased 36% whereas fluoroquinolones decreased 34% from 2014 to 2015. the largest increases from 2014 to 2015 were seen in piperacillin-tazo- bactam (81.5%), and in gentamicin (500%). conclusion: the consumption data for antimicrobial agents are based on purchases and fluctuations are therefore seen from year to year. however, as a result of the increased focus on prescription of antibiotics (especially at dronning ingrids hospi- tal, where teaching on prescription and antibiotic audits are performed on a yearly basis) a continued increase in purchase of piperacillin-tazobactam has been seen. a remarkable increase was also seen for gentamicin. due to the change in treatment of gonorrhoea a decrease in purchase of fluoroquinolones was seen. it is ? however - a bit worrying that the purchase of merope- nem has increased again after a decrease last year. continued focus in greenland on the use of broad-spectrum antimicrobial agents - both in hospitals and in primary health care - and on the incidence of sexually transmitted infections, e.g. gonorrhoea, as well as on multiresistant bacteria is very impor- tant in the future. anne kjerulf, jette holt, anne birgitte jensen, sine berntsen, michael lynge pedersen, jørgen skov jensen, peter poulsen, inge mortensen for further information: anne kjerulf (alf@ssi.dk) continued ... textbox 5.1
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